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CHAIN OF CUSTODY RECORD OC Lop Number <br /> Client harps A Projact or PON Analyses required y <br /> H t. '� .9i <br /> Address, ' %% <br /> PAone W� q 3 <br /> Z3 5 i.s vtie - , ) 4(q 0 1Z <br /> Cit State,ZIP , ' • Report etlantlon � <br /> a�rccw.t?�,ko '�.• �f S$t'- �v� PI�►;ll� � �� �� �� <br /> ' T a' Sampled by 'lirf <br /> Lab ,Y� 1 th Number <br /> 5erople 'Dole Time See key 01 <br /> number atamplgd.. '. sampled below Sample description conlalnors � �� �ro�� <br /> Remarks <br /> �� Aix� �lz z•a� G� 5 .- - ... ._. _.._... - <br /> R FIs L-Sd. 5 <br /> F , <br /> Signature Print Name Company Dale The <br /> Rallnqutshed by Zgz:,V711-4� <br /> V t t G l 1 q�34�c 10. eO <br /> Received by <br /> lo.: <br /> Relinqulshed by <br /> Received by <br /> Relinquished by ; <br /> Racelved by Labor4lort, . <br /> BROWN AND CALDWELL LABORATORIES Nota: <br /> R 0 1255 Powell•Slreai,$msryvllte:CA 04808 (4151428.2000 Samples are discarded 00 days allot rdsul'Is are reported unless other arrangements are.made. <br /> Q 070 Soutri 64 Qski Avenue,Assadena,CA 81105 18191795.7553 <br /> Hazardous samplos will be roturned to cttenror dispoted of al client oxpense. <br /> 1 iZ00f'scjiicoAvo" ',Anliholm,CA 07605 'KF.Y sn _+nucoi� �r� Hn <br /> — nanusrux RI:—QI,Omn MI.' <br />