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"RecJrtin� lnrA Clrunrr t:ncirunnient•' <br /> Chain of Custody. <br /> 2000 North Alur]Iedo Str•L'et•COMI)tOTI,C4 90222 , — L <br /> (3in).53,'-7100 Far:(31o)639-1254 Date Page L of <br /> C,i4)FISGLLYCert�[srte�2037 <br /> Client: lit JJ ++ Contact: L Tel: <br /> �I f �F C�-t`' (�,�-.,,1 �; �, �,,,;� �G✓��' ��� � Z- Fax. <br /> Address: City: State. Zip Code: <br /> P7•oject Name: C br isd-Lp �� Sampler(s) Signature: - %\ <br /> Project Manager: (� G Approved By: <br /> IN <br /> Due Date (] Regular ❑ Rush Days Comments: <br /> Lab Date Time No. of <br /> Sample Description ID Collected Matrix( Containers Analysis Requested <br /> (- vel. k <br /> Sample Conditions: Seal ❑ IntactQ Broken ❑ None; Temperature ❑ Cold ❑ Room; Other <br /> Relinquished by (signature) (�/ <br /> Received by (SigTtature) Date/Time L 14,2-3 tri, <br /> Relinquished by (signature) Received by (Signature) Date/Time ��z <br /> Relinquished by (signahtr e) �— Received by (Signature) Date/Time <br /> SPECLAL INSTRUCTIO J i _ <br />