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EXON COMPANY, VSA. (west st) CHAIN OF CUSTODY RECORD N0. P ,_�= of Z <br /> Exxon Engineer Phone: �-5- <br /> y` )( ANALYSIS REQUEST: <br /> Consultant Co.. Name . '7- 8.� --. _.. r.:. :w _ - (CHECK APPROPRIATE.BOX): _ _ �- .. r w <br /> f OTHER <br /> �— Contact:�-cl l<. <br /> Address: 2 2 �� /110TC!/a A- c �,j Q 2 L 2 <br /> r Fax: ❑ ❑ o ❑ ❑ Cl <br /> �t'�}'l,, f�• /1 lei- 3 `� © � <br /> RAS #: 4V Z _ ° a <br /> ❑ <br /> D v o Oz J -� ❑ <br /> Facility/State 1D# (TN Only): a > L) <br /> AFE #(Terminal Only): Consultant Project#: 'i 2 . �` W o 0 © ° a a a a ❑ z <br /> Locatio ` f �l / ��r A r /felt .k p ❑ w N W <br /> n (City) O (State) (� ;gyp o M rr <br /> EE m a <br /> CJ CRME3 SDT 0 M o m ❑ 171 ❑ a <br /> Consultant Work Release#: 2 d a N 0v N ° o m w0 C1 <br /> a <br /> Sampled By:-- P' ' PF 8 z m z r ° W rJ <br /> SAMPLE I.D. DATE TIME COMP. GRAB MATRIX _ o ~ `(D x W 0 a a ¢ w o <br /> 011-tER PFESFFVAIW `: W m > C7 J m c7 — <br /> y o SOIL AIR z 0 m o o n d Q w zi F o <br /> 1IL�s x <br /> rh14 ` k <br /> L�2- <br /> � <br /> rr K _ <br /> V / 1�3� T 1C y <br /> TAT SPECIAL DETECTION LIMITS (Specify) REMARKS: <br /> 24 HR. 72 HR._ <br /> 46 HR. '. 96 HR. <br /> —_ EXXON UST <br /> 8 Business 'Contact US Prior CONTRACT NO. SPECIAL REPORTING REQUIREMENTS (Specify) LAB USE ONLY Lot# <br /> to Sending Sample C41483 Storage Location <br /> Other PDF O ❑ Epp <br /> QIUpC levet <br /> Standard CLP❑ Other 0 FAX ❑ C-O-C W/REPORT lI r}��V <br /> WORK ORDER#:v LAB WORK RELEASE#; o� z <br /> Relin 'she Sampler: Dat Time Received By: <br /> CUSTODY Relinquished: �, �G'U <br /> Date Time Received By: <br /> RECORD <br /> Relinquished: <br /> Date Time Received By <br /> l <br /> Triplicate: Way Billyrn 12 <br /> Original •White Lab's Copy •Green Client Copy •Yellow Cooler Temp: <br />