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0 0 r <br /> CHAIN OF CUSTODY / ANALYSES REQUEST FORM <br /> Project No. ! 6 f G r Oo , Field Logbook No. Date. �Z& Serial No. <br /> Project Name: �1•r}Go f� Project Location. k�Soc 2 a� � N_ 11595 <br /> Sampler (Signature) ANALYSES Samplers: <br /> SAMPLESX L <br /> DATE TIME <br /> SAMPLE NO. LAB SAMPLE NO. OF SAMPLE �" P `�J <br /> N0. TAINER5 TYPE Q REMARKS <br /> Mw -7 F1121% ZZ3o 34ZO <br /> NILtl- $/1Z/9 Z3 a0 3 HZO G 2 IAL L L <br /> Mui- FSIIZ1=tb Z3 OZ, <br /> Z0 <br /> ul- 3 /13/% t2DZQ 3 H20 <br /> Mw , i3 -Quo 0 yL0 <br /> I�w &1;lMb01 0 ? tg20 <br /> Tr, t���til- �i'rz1�16 $DD 3 Lo <br /> RELINQUISHED BY DATE I TIME RECEIVED BY E TI E / <br /> (Signature) 1/7 C OP60 (Signature) C <br /> RELINQUISHED BYjr �, TI ` RECEIVED BY DATE TIME <br /> {Signature) �l (Signature) <br /> RELINQUISHED BY- DATE TIME RECEIVED BY ,rI ( DATE TIME <br /> (Signature) (Signature) Vic,_, <br /> METHOD of SHIPMENT DATE TIME LAB COMMENTS <br /> Sample Collector LEVINE-FRICKE Analytical Laboratory <br /> 1900 Powell Street, 121h Floor <br /> Emeryville,California 94608 <br /> (510)652-4500 <br /> Shipping Copy (White) Lab Copy (Green) File Copy (Yellow) Field Copy (Pink) FORM NO. 86/COC/ARF <br />