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T ] [� CHA N OF CUSTO IDY iRECORD Page L. of� <br /> Environmental and Geotechnical Consultant 555 Montgomery Street,Suite 1300,San Francisco,CA 94111 Ph 415.955-90401 Fax 415-955.9041 <br /> 2 Theatre square,Suite 216,Orinda CA 94563 Ph 925-253-49801 Fax 925-253-4985 <br /> 501 14th Street,3rd Floor,Oakland,CIA 94612 Ph 510-874 5001 Fax 510-874-4507 <br /> Site Name �a _ f II '1 <br /> Job Number 2 p IIx At:alysts,Requested4"'; <br /> Project ManagerlCont'ct MA9PP-CF5 <br /> Samplers <br /> Recorder(Signature Required) ICL <br /> No Containers <br /> Matrix &Preservative 01 <br /> Field$amplB � _ ' , L � o @ a� v °' D °° <br /> identification No" a ate,"' ', <br /> [� ��Time ,� t..aba5ample No` <br /> ESM210k$ �! <br /> t b S !O•oa <br /> HDL:P <br /> +I-2- <br /> V2-,e;, <br /> Sc w lac 1S-Do <br /> I ` <br /> I I <br /> ! 1 <br /> Reis sh d by Dat Tlme Recelked by (Signature) Date Time <br /> lZ� !{ / / ® l f 3 <br /> e n u� hed by {signature} Date Time Received by (Signature) ate Time <br /> t li II <br /> Relinquished by (signature) D e Time Received y Lab (Sign ure) Date , ,,/r Time <br /> Sent to Laboratory(Name) ?Yethod of Shipment []lab couner Eked Fac [—]Airborne �uPS <br /> Laboratory Comments/Notes Hand CamedE]Private Couner(Co Name} <br /> White Copy-Original Yellow Copy-Laboratory1 pit Co <br /> py-Field COC Number 002793 <br /> I i <br /> I <br /> I � R <br />