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"IN 9 • e <br /> CHAIN OF CUSTODY / ANALYSES REQUEST FORM 61 0 250 <br /> Project No. : (� r 6 `D I Field Logbook No. : Date: Z lq� Serial No. <br /> Project Name: I ) Project Location: Q 11724 <br /> Sampler (Signature) A E.S Samplers: <br /> P L E A- ,�\ �O ��` NPD <br /> N0. OF QP \ �� Q-J <br /> SAMPLE NO. DATE T I ME LAB SAMPLE CON- SAMPLE �QQ REMARKS <br /> NO. TAINERS TYPE <br /> 02�!g <br /> 2 o3A� , wt <br /> U.l l <br /> S <br /> Jo rte' e- <br /> RELINQUISHED BY; RECEIVED BY: D <br /> P EAT TIM <br /> (Signature) (Signature) <br /> RELINQUISHED BY: TE I RECEIVED BY: E TIME <br /> (Signature) �; S (Signature) �� —�-1 I (� <br /> RELINQUISHED BY. ATE TIME RECEIVED BY: DATE TIME <br /> (Signature) (Signature) <br /> METHOD OF SHIPMENT: DATE TIME LAB COMMENTS: Pl G�` S(S s�r T Yiprk, IA ( <br /> Sample Collector: LEVINE-FRICKE Analytical Laboratory:/ ' <br /> -+900-RawefF-She t,t'ih-Fio-or <br /> •Rm�ry�lle-��- i:' r <br /> (4-1-5)-652-4500— �.: AL <br /> Shipping Copy (whit..e) Lah Copy (Green) File Copy (Yellow) Field Copy (Pink) FORM NO. 86/COC/ARF <br />