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Sample Ida <br /> ntifi:;Von/Field WCO of Custody Record <br /> DELI A <br /> ENVIRONMENTAL CONSULTANTS, INC <br /> t <br /> Project 1WtD dlnro�ti,� �'rL7{ 5h���� w # �7��~ R - /�tl�a <br /> Shipped by T W e cti t' - <br /> Shipped to C' �-�� �� — - - -_ Attention of <br /> Comments Hazardous materials suspected')(yesno <br /> Sampling Sample No of Analysis <br /> Point Location Field ID Date Type containem Rupred <br /> r <br /> s 613 ? Ib.5 ' ' ' S(3 -8 lb.5 ' <br /> i <br /> 1 <br /> I <br /> i <br /> s <br /> I 'I <br /> `f f <br /> Sampler(s)(signature) L4r�!2:.L <br /> Fiold ID Relinquished by (signature) Received by(signature) Datemme Comments <br /> L JSC <br /> L� 1 <br /> �r'� :p �_�� /t M Shipment Gr�� <br /> Sealed for shipment by (signature) _� � � �--'� Date/Time pment method <br /> Received for Lab by (signature) _ <br /> �' �`- Datefrime. IL/0-95 /o So Comments �f��•J��< r {��/��.S�cl <br /> i <br /> Receiving Laboratory Please return original form after signing for receipt of samples <br />