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u AwVIN <br /> u <br /> DATES ` PAGE_�OF CHAIN OF CUSTODY RECORD <br /> j <br /> PROJECT NAM E��cG( ANALYSES TO BE PERFORMED MATRIX Environmental <br /> Science & <br /> ADDRESS S3 6�:MVee <br /> N C Engineering, Inc <br /> t�_ Sir .cncanr c�..r <br /> PROJECT NO. �;P 5- Gd T B T 4090 NtNon Avenue Phone(510)685-4053 <br /> R E A st„lc) <br /> SAMPLED BYG I rc.l a X R Concord CA 94520 Fax(510)685-5323 <br /> . <br /> LAB NAME F R r { <br /> REMARK, C <br /> SAMPLE # DATE TIME LOCATION MATRIX S (CONTAINER, SIi, i <br /> 3 o y s 4s Elsa st"V4 ( r T 4 <br /> r ' <br /> s E'20 <br /> ij <br /> o o 521 <br /> X52"2 <br /> -,` 4 r <br /> a <br /> 91525 <br /> _ r <br /> 4REL ile <br /> SHtt-_ (signature) RECEIVED BY: (signature) date time /a <br /> 1. TOTAL NUMBER OF'PO <br /> i <br /> 6 45 9 y5a � <br /> 2 RESCI <br /> ULTSREPORTTO: REQUIREMENTS ► ' <br /> 3 . <br /> 4 . <br /> r <br /> 5. L <br /> SAMPLE RECEIPT <br /> INSTRUCTIONS TO LABORATORY (handling, analyses, storage, etc. ) : CHAIN OF CUSTODY SEALS <br /> 'M .RECID GOOD CONDTN/COLD <br /> ��� (} PCGN _ CONFORMS TO RECORD <br /> HEAD SPACE ABSE➢ICF� C �� <br />