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r 1 x ' <br /> Record <br /> Cha,.'I ®f 8Custody <br /> ®ANALYTICAL LABORATORIES, INC. 'tDate ffPage 2 Of <br /> PROJECT NAME STAti �y�F �r �., C GUMS INORGANICS OTHER REMARKSLU <br /> } <br /> PROJECT No. v <br /> SAMP ERS'(51GNA�RE}�;,' - 1 = zo <br /> f"- a l z s v col �3 w O <br /> LL O O O O O V LIJ <br /> J 2 a .{ <br /> l LXUCq CD <br /> @ CO C? ONO <br /> 1 PRINTED NAME Ocn C5 CM <br /> F.;~•` <br /> SAMPLE NO! DATE TIME LOCATION <br /> zx 1A <br /> I AI <br /> l M UJ-''2 9 <br /> "i <br /> • J <br /> I I <br /> r I <br /> 1. <br /> RELINQUISHED BY DATE CEIVED BY DATE RELINQUISHED BY DATE RECEIVED BY DATE TOTAL NUMBER 4r � <br /> OF CONTAINERS <br /> . ��� METHOD OF SHIPMENT <br /> 5_ig@ahere. i r' l Si nnaturo Signature Signature <br /> I t3 �� NT TIME TIME Printed Name TIME <br /> Printed Name TIME Printed Name Printed Name <br /> ,D%�j E ,C6 SPECIAL SHIPMENT HANDLING <br /> Company;%[r4 A +�r J Company Company Company OR STORAGE REQUIREMENTS <br /> RELINQUISHED BY DATE RECEIVED BY DATE RELINQUISHED BY DATE RECD By(LA70RATORYr DATE <br /> Signature I Signature Signature Signature ' <br /> Printed Name <br /> TIME Printed Name TIME Printed Name TIME printed Name TIME <br /> 1 i <br /> Company Company Company Company <br /> 60OW Norih Market Boulevard Sacramento CA 95834 Phone(916)923-0840 <br /> { S <br /> i j <br />