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CWHi CHAIN OF CUSTOD r <br /> PROJECT NUMBER ECT NAME L.... ___ ,.� ,,.r,r�..._ _. ANALYSES REQUESTED FOR LAB USE ONLY <br /> c ,# 3 LAB _ <br /> CLIENT NAME <br /> 11 PROD <br /> REPORT TO: L COPY TO: a �t-Ua ACK VERIFIED <br /> . U, } DATE INVOICED <br /> REQUESTED COMPLETION DATE LABORATORY <br /> p2 C.t�1�•`> U. <br /> 0 t j ' K ' NO,OF SAMPLES pg of <br /> CL Lu <br /> STA WEDISPOSITION: D R <br /> � <br /> NO DATE TIME C1 SAMPLE DESCRIPTION z J REMARKS <br /> D15 L , -------=- `f <br /> — _-.._ - -- - --- -- ;- - --._...--- - <br /> SA�iWl)BY AND E(SI TORE) DATE/TIME RELINQUISHED BY NA RE) DATE/TIME RECEIVED BY:(SIGNATURE) DATE/TIME <br /> � 6 �1 2 gel 3 <br /> ELINQUIS D BY:(SIGNATURE) DATE/TIME RECEIVED BY:(SIG NA E) DATE/TIME RELINQUISHED BY:(SIGNATURE) DATE/TIME RECEIVED BY LAB:(SIGNATURE) DATE/TIME <br /> C 5 6 7 0" 7/9/6 8,3� <br /> c <br /> 11 D. . SAMPLING PROGRAM SAMPLE?SH!rKD VIA AIR BUS BILL NUMBER <br /> EMARKS SDWA NPDES RCRA OTHER ❑UPS BUS 13 FED-Ex <br /> ❑ ❑ 11 (SPECIFY) ❑ HAND OTHER <br />