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"IN OF CUSTODY kECORD <br /> Project No. <br /> project Name <br /> Somme and —` �t f�[G�__�^/Gf OrL Affiliation: �1tcl> r l/ ' f�,C4 <br /> Ularee and <br /> Sionature) ?/J.3 '' S� ` �Q, q-113 i ( qR J <br /> Shipped to: —_ p(� -��_-- Shipped by: Da <br /> te Shipped: <br /> Na.;e — �--Name <br /> Address Address <br /> Tel bone Telephone -- <br /> Collector's Sample Samole No. of <br /> Sa::Ole )le. Location Date Time Tvice Containers Analyses (leouested keaarM; <br /> : <br /> q <br /> - -- -- ---- ---- - ��--- --- --- --- ------ -- --------------- <br /> XL'�Zc�i' --n1eF._cicl-y,�aslu,r_ �1.1 <br /> ------- - <br /> ---------- ---------------*----- <br /> - ----------- ------ — —►!! ---- <br /> -------------- <br /> -L----- -- -- --------------------------- ------- ---- ----- - <br /> / ----------- - ------- — <br /> (I_LL.li a. -- - -- --- — - --- -- <br /> ,� <br /> t1=° -�-- ---�-------��fa :. ---------------------------- <br /> ve---_------ ----------- ----- ----�-� --- <br /> ___ _-_----_----------------------------------- ---------------------- - <br /> Relineuished by: I Date/ Time II Received by: 1 Date/ Time II Felirquished by: 1 Date/ Titre II ;Sic, <br /> eival b/: Dare/ Tine <br /> Moorature) 14J2�1 11 (Siena ur 1 I(/Z-y/I 11 (S /Siicnaturyly / I II ' e) I <br /> /d� 3 — l3? Cl <br /> . lirouisyed by: I Date/ Time 11 Received by: I Date/ Tixe II Reliruuished by: I Date/ Time II Received by: I Datr/ 1:=r <br /> (Siorature) I I II (Signature) I 1 11 (Signature) I I II lsioNtuu e) I I <br /> 1 I II I _---- ----- -- <br /> LEEDSHILL-HERKENHOFF INC. <br />