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5 <br /> i <br /> I µ <br /> I i <br /> DATE I PAGE--I--OF--Z— CHAIN Oi USTODY RECORD _ E <br /> Environmental <br /> PROJECT NAME ANALYSES TO BE PERFORMED MATRIX Scien[e <br /> { <br /> ADDRESS //p u!. 7—L4.,oQ Rocx c� N C Engineering,Inc. <br /> M U 0 <br /> L `^ A M N • 2�.�.. <br /> T B T $97 Center Avenue (415)372-3637 <br /> PROJECT NO' 9D - 50 4 <br /> R E A Saite350 V' I <br /> SAMPLED BY: %V e_ ( /�,� �^�yf X R I Martinet,CA99553 Fax(415)3J?_3%90 <br /> LAB NAME 1 v F R REMARKS ;F <br /> SAMPLE ! DATE TIME LOCATION �4 "IS (CONTAINER, SIZE, ETC.) <br /> MATRIX <br /> Pat 1l 7~ir-7- 7C ix sd l luau fry_ , <br /> 216 1 XMW a <br /> 1� <br /> J tt __ <br /> �� — <br /> (5X X <br /> def 1 1 X ( <br /> IAAf�C Y 3 a-`7o s sod r X Xle z— <br /> RELINQUISHED BY: (signature) EIVED BY• 1 ignature) d to time TOTAL NUMBER OF CONTAINERS <br /> REPORT SPECIAL SHIPMENT <br /> 2• :n1 .u�x mac-- i D !o:qo RESULTS TO: REQUIREMENTS " <br /> s i - <br /> 4. <br /> 5. SAMPLE RECEIPT <br /> INS,TRUCT IONS TO LABORATORY (handling, analyses, storage, etc.) : CHAIN OF CUSTODY SEALS <br /> fit,• e.c��- ����C r "' <br /> / ���r11'4ti( 7Zt�'/1GLc?a7 ca 77r1t{�. RFC'D GOOD CONDTN/COLD <br /> CONFORMS TO RECORD <br /> i <br /> i <br />