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1< <br /> ENTERKLAMOTP3F,L R/A Control No. "� 4J <br /> CORPORATION CHkI -CF-'rUSTOD Y RECORD <br /> C/C Control NO. 5 0 <br /> PROJECT NAMEINUMBEP. ..� v� _ V a �'4 LAB DESTINATION (! YY/lgr��!.f�1 <br /> SAMPLE TEAM MEMBERS IV <br /> + <br /> — CARRiERfWAYB1LL NO. <br /> 3 <br /> SzlrnQle Sam N: Gate and`time $ample Container Condition on Receipt <br /> Number Locabw cod Description Collected r s <br /> � Type Type (Name end Gate) !`setor�t No. <br /> 0)j 1710 5ar. { <br /> r f L—�- f <br /> _ <br /> SSS — z.- s <br /> 2 t Zo <br /> �.- <br /> 55 —PZ—.4, <br /> y r .r. <br /> ' ce' <br /> � �f <br /> $55 13-1 !' I630 ` <br /> � r 635 i_'• �� - <br /> Special Instructions: <br /> .� <br /> Possible Sample Hazards: <br /> � �. <br /> SIGNATURES: (Na Carr�p3ny.Dat and T:rr����� <br /> 1. Relinquished By: ,�. 3. Relinquished By: <br /> Received By:! � Received by: �sr1 <br /> g `'; <br /> 2. Relinquished By: .5 <br /> 4. Relinquished f3y: <br /> Received B <br /> Y' Received By: <br /> F ; A <br /> �.._.. �HITEi 'xorn� . ..m ._ .- i ' 1, <br /> YF-LLOYF-Field COPY <br /> , <br />