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4946 Watt Avenue, #38 <br /> EXCeFRem North Highlands, CA 95660 CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Environmental Labs (916)334-866I <br /> Project Manager Phone# c�of � C�r !� <br /> ANALYSIS REQUEST U f `� TAT <br /> ,G <br /> WET <br /> Company/Address FAX# I <br /> • Y <br /> _ TOTAL(r) <br /> Project Wmber P O# Project Name L t `o <br /> o = <br /> pNp r�- Ui � <br /> .t f•' ti"► a W O C d Q N <br /> Project Location Sampler Signature m `-70 w w <br /> �, 0 Ln <br /> N H V N <br /> +?M .? Go IIv1 l0 Op 7 �1 <br /> N _ <br /> UJ 111 <br /> Method a �ry v 0 ua IV w a s o y 0- N z U v, u <br /> Sampling Container Matrix No b m 8 e C'3 h o 0 C b v o w U y i7 i7 <br /> Sample Preserved a = Cd CD Q T !e 0 0 N a L i a <br /> LU <br /> N v a o 0 c1� o N N z y a ^ a cn 0 <br /> D ¢ ro w w m m _ m co m co Q p U = w z <br /> BATE TIME a �_ x �ry a rn Q <br /> O -1 o a U z "" O Q p H iw- a a o o ca a Q as a s a s 0 a a w X F- <br /> � m Y r z v z 3 rn m Co F W rn www w w w w O a: U w U Q iu c) <br /> Lam'q --ID AIA6 IF 1qt) —+.:E 1� C� 5 <br /> SO4Q 33 � <br /> 566 X33 -7 <br /> il S0 8 1 6 3 3 <br /> .r. 0 I I I I +T1— j.� 1 5 OSaIC337 <br /> � 0g463 q0 <br /> � a0- cl ( 3q <br /> 35 JS09q (o34a <br /> p � 0 $ Q (034 3 <br /> 6g 63 <br /> SQ 01q � 3y <br /> Rel: quis ed by Date Time Received by Remarks <br /> A <br /> Relinquished by Date Time Received by <br /> Relinquished by Date Time FKceived by Wboratory Bill To <br /> alt� <br />