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7( S'Y'q Y'7- W15-4, <br /> "S,L)B11 fl ,. 9(.-,0G79(.-, REFI:: a 8 3�ql <br /> Hygienetics CA1) .A'E 1,1 T:: I-I Y G <br /> U 1H., 6/2 6 9 <br /> Environmental "03 9 9 <br /> Airport Corporate Centre - 7677 Oakport Street,Ste. 1150 • Oakland, CA 94621 Chain of Custody <br /> (510)430-2843-FAX.(510)430-9268 <br /> Date —page Of <br /> Lab Name Ckre*-. 66 Analysis Request <br /> Address 06-Lo QV-0-,Yq L^16 <br /> Pfe-Qs,,+., "e-A 9145U <br /> Telephone �--Ia) <br /> . C a c . IP <br /> 0 E <br /> 0 0 0 C 0 - <br /> 0 7 >M <br /> 1 0 U O a 2 .� U 0 <br /> '? 0 <br /> 0 C 0 <br /> E @' 0 <br /> Samplers(SIGNATURES) 0.N� Ei <br /> o 5 E �0 <br /> 00 <br /> Ql t00 > u, a, X R -a E <br /> 0� <br /> 7@ <br /> dm t"N. -Do 08 T. ;o :L <br /> d- d- E <br /> o E <br /> E2 2 2 c.- -I� � 0- -a A E <br /> Sample Number Matrix Location 2. oa -60 o Q o L) Q 0 02 o16 < t: w <br /> .1 . o w <br /> Q.X f-2 P x tr a.2 Q d: cc 0 0 on <br /> ca <br /> 3:> w lo lo a.XI: >(9 0 <br /> 1045, /J,- <br /> % <br /> 14 0 NY, Ave'.4 <br /> %0 so.* 1 0 6' <br /> 0 <br /> Project Information Sample Receipt Relinquished By I. Relinquished By 2. Relinquished By 3. <br /> Project <br /> Y-C'If'). fe--P-r�C,W5 Total No.of Containers lja� 17 39 1 <br /> (Signature) to (Ti e) (Signature) (r ime) (Signature) (rime) <br /> Project Director W.C- .flol'),e-v- Chain of Custody Seals <br /> Charge Code No. )1-3 4 0 Q jj Rec'd Good Condition/Cold (Printed Name) (Oate) (Printed Name) (Date) (Date) <br /> Shipping ID.No. Conforms to Recordd404A(Com$any) (Co y) (Company) <br /> Lab No. Received By I eceivecl By 2. Received By(Lab t 3. <br /> Via: <br /> 1 i(Signature) (Time) (Signature) (Signature) -., (Time) <br /> Special Instructions/Comments: Like,, -x-�ie--,, M irn4,LQ�L (a <br /> (Printed d Name) (Date) (Date) (Printed Na Date) <br /> (Company) company) . l(Laboratory) <br />