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i <br /> E A R Ttt E C H Chain of Custody Record Lab job no. _U/—// 91 <br /> Dale JU-/6�y — <br /> Laboratory S i— SL�i(G.L Method of Shipment .2L ,_ rp'.f�j -- <br /> Page �—of <br /> Address 12-2-0 Qugi!v <br /> Shipment No. <br /> ?L kA SA w I Or.1 , Lot <br /> Airbill No. —� � Analysis Requested <br /> _--- _ <br /> Client Q I a7w-Lw _. Cooler No. <br /> Address As �-,Lygp- USS ( -Lv_V Project Contact <br /> —� `3DS L, OA , Telephone No. �o Z�'z h <br /> � 4Z, <br /> -1718 LO ft_fc:rf��it cs r--lZ c Hoz 3l -2— - <br /> 1 <br /> Project Name T � Fax.No. <br /> Project Number O`I 9C Samplers:(Signature) et, <br /> �+ <br /> H <br /> Field Sample ID Matrix Sample Sampling sampiiry Type/Size Preservation , V Remarks <br /> P Depth Interval Date TR1e of Container Temp. Chemical ' :� <br /> MLL�'1—ycotfoL°�S Lf�%J l —C�(o�l 0 23 0 <br /> �-- —-J�j. TIA^IA (c. <br /> — V I U OS- T Vi 23' GL �J 3 X _ --- -- -- -- <br /> Ft�L� in <br /> -� i`rLyElsm w <br /> _ /LzQ$T L _ _ — — -- --- — <br /> t � ch <br /> raw'L 3 -.�_— ———-- - ----- <br /> tv / J3 PoLV hU3 I X -- — — —�-I L�cE t <br /> 1113 i ►� ( K <br /> VUP- t1 — <br /> Relinquished Date Received by Date Relinquished by: Dale Received by: Dale <br /> Signature - Signal re Signature <br /> TAU(.- (�,� Signature <br /> Printed !Lt�'(•' I�aYI� _ �� 1 Printed _ <br /> �iwY l Time Printed -[,/ Time Time Printed <br /> Company [ll�T� a��i•tl C- r ��� Company ----- --_ Time <br /> Reason --! D l.J I�? Company`�"-��''" -`ter t �-1� _ I Reason — Company ---_— <br /> L+GA*I ,Ia 7/� .�- ry �j /AA y" 1 Relinquished by: Dale Received by: Date <br /> Comments �1 tT7111�►1 F-Y (�^1 r, C- !1 r� Signature. <br /> TO 8CL&A t�tA��Q�\o SLI' �.K• CO V\ - Signature- <br /> - Printed <br /> Company <br /> Time Printed Time <br /> -- -- '---------- <br /> Reason -- Company --- <br /> DISTRIBUTION: While to Laboralory•Canary to Earth Tech Project Fite,Pink 10 Field File <br />