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Xennedy/Jenks/Chilton, Laboratory Division <br /> Field Samole Chain of Custody Record <br /> Source of Samole(s) Gi9L— AiPl1'I $'(�QC�f Collector <br /> adrssszO�d lt'. 9qAy///� ST. Affiliation <br /> S C TIJiCJ Address3 -75 <br /> -- . ,w&Liz <br /> R2?ar to (I) ?hone <br /> Samoa_ infar+..a=TaR </J/C Jar} lumce- �Zs <br /> ijga <br /> Lao Na . Reid yo . Dz_a Time ( 2) Deo:n Ranar'cs (SuSoec ad Cart_zminants, <br /> Fiera CcrtQTLTons , 2cc.) <br /> E <br /> CnaTn at ?as,cs_tan <br /> y <br /> II <br /> ReTTnauis�� aa.c f _ t - <br /> e -,me Racal ve by 3) E3a"e i T«,e <br /> (STanazurz- ana ai-f Tl Ta%Tan) {�iQFfcilr2 c�1II off i l iatiQnj <br /> z_ <br /> i _ <br /> Laage�+ i n a-c ,t/J/C by / 1 <br /> (?) A se?arara Re,ues. far Analysis 'For„ is to be filled out ay the collector ana given to <br /> the Laaaratory wnen samIIles are derive—sd. (Z) a.g. wa%ar, 5iucce , salt , arc. (3) If any <br /> samII i es are fiat T n-7c- at time of ti ans�a'', please desc;i oe an %he oac'< of this F ars. <br /> Each Jcit=n Of ? Or i'='VEi' Sa'13II1 as: e, �aCn ITS4�i i ��►Q� (sal T , Nazar•, a--_.) mus-. 4 ricT fide snaugn <br /> Of One 5aTTile f^r anaiysis. - <br /> l RN:AG 7hese ;aiuias cantain unk„awn C,em-�c_ls -vnicn , coon analvsis , may ze ce-:z a,ne^_ zo <br /> -fre "(-,awn :J :^a s:._` :J ra�ca r,nc�z'' 1�"�=r;QllC�i _.�." is _ -UfiC?'' L`e 1 Ea- <br /> _ <br /> �rii'C ilCi Yi-��'•• ��� �:i Lti � :r��rer- �r - CNV 1 ]' ' �� , � t urs- <br /> J <br />