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w. <br /> SAMPLING/ANALYSIS REQUEST AND CHAIN OF CUSTODY RECORD <br /> Project No. I°� o o I Re nested B <br /> �r i Q Y• P.O. No.: <br /> * REQUEST I <br /> LABORATORY REQUIi�EMENTS CHAIN OF CUSTODY <br /> SAMPLE TYRE: 4 l <br /> rr CONTAINER tCONTRACT LABORATORY ', x <br /> j' SAMPLE I.D. PAP-WETERS SIZE PE <br /> !T� QUANTITY ,PRFs. LA8 DATE SAMPLER SAMPLE DATE RECD BY COMMENTS DATE <br /> -i a �� $ tIUH�Vo !F 11.c r n RECD <br /> NP / �r�►a J�`7`�r 1`�r�Sd 1� <br /> me/ <br /> _ 0 ' m <br /> . r�/Osr1+C S <br /> _ wG5-eA � .'� <br /> _ U_1( nod' <br /> �` I.. a cie,. <br /> F <br /> I <br /> SIGNATURES: <br /> Fie'nquished 8y(Sipnattire) Or anixallon <br /> bate/71mO� Fla a By{Sign lure] Orpanfxatfan Dete/Tima Turn Around limo <br /> �+ �O y !.�• (CircteChoiee) <br /> -- 7iellnquished 8y ISignmurel - Organixaltan - Dme Into 1loeolvo 51 nelu <br /> Y I g Orpe ixetion Dara/Tina 24 Hrs <br /> 48 Hrs L <br /> RelintyuiSlrCt!Sy(SipnplutCl Organlzalien. Dole/Tlrno RCCOlvEld For laboratory BylSignelure) Dale/Tlme 5 Days " <br /> riAr+instr� Y':1U't►1Ts�lwrUav,N, A <br /> i <br />