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CHAIN-OF-CUSTODY RECORD W Date: Page of <br /> Project No.: ANALYSES REMARKS <br /> 12 <br /> Samplers(Signatures): o R N v n .� Additional Comments <br /> v avr, v v¢ 8 <br /> a <br /> a a t- a a > s z <br /> Dale Time Sample Number w w w w m w w w 1,r- r- rg r9i o 2 z <br /> Tam around lime: Results to.. <br /> Total No.of containers: <br /> Relinquished by(signature): Date: Relinquished by(signature): Data; Rellnquishad by(signature): Dale: Method of Shipmenl: <br /> ------- Laboratory Comments and Log No.: <br /> Printed Name: Printed Name: Printed Name: <br /> Time: Time: Time: <br /> Company: Company: Company: <br /> Received by(signature): Date: Received by(signature): Date: Received by(signature): Dale: <br /> Piloted Name: Printed Name: Printed Name: <br /> Time: Time: Time: <br /> Company: Company: Company: <br /> GEOMATRIX <br /> puuns(PF)012b (Revised 12105) <br />