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..J <br /> i <br /> 77 <br /> -71- _ i. ..• .. 1 I _i .. d.,.m.� �5.:•�ku - F. (• '. <br /> . ';1Ei Wj49T Chale' "I of Custody ec®rd � 3 <br /> ANALYTICAL LABORATORIES, INC. I Date Page / of <br /> PROJECT NAME GC ' <br /> GUMS INORGANICS OTHER w REMARKS <br /> PROJECT NO. <br /> w <br /> S ERS(SIGNATURE) ," z <br /> `a �w <br /> Cl <br /> I� z at ❑ U <br /> f" F <br /> �tco it <br /> WX JN rl n O <br /> o 10 <br /> m vcc <br /> PRINTED NAME co <br /> m v co cno W W <br /> 7. <a tSAMPLE NO. C. <br /> ] m ' <br /> � <br /> z <br /> N!t�i- t. IG ire r.v1 ,, ✓ `.ur. - r `� <br /> Lv- <br /> 2. <br /> :h <br /> lei <br /> f <br /> is <br /> - 1 ,- }f <br /> i <br /> RELINQUISHED BY DATE RECEIVEQ BY. DATE RELINQUISHED BY PATE RECEIVED BY DATE t � TOTAL NUMBER <br /> SignatuOF CONTAINERS / f' ` �• = <br /> Signature tJ re O b tSi nature <br /> �j.�� �• �'�` �,� g Signature METHOD OF SHIPME <br /> Printed Name, TIME Printed Name TIME <br /> Printed Name TIME Printed Name TIME <br /> ,�t: f ,.,�,F ', 1015 t 4, 1015 <br /> Company/fw c. -„ :. Company Company Company SPECIAL SHIPMENT HANDLING <br /> • RELINQUISHED BY DATE RECEIVED BY DATE RELINOUISHED BY DATE RF'D BY.(LABORATORY) DATE OR STORAGE REQUIREMENTS <br /> Signature. Signature Signature 5i nature vY <br /> 9 , <br /> Printed Name TIME printed Name TltulE 1Printed Name TIME Printed'Name / TIME <br /> Company Company Com an rr; <br /> P Y Company <br /> 60OW North Market BDUlevard Sacramento,CA 96834 Phone(916)923-0840 <br /> 'a <br />