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Kennedy/Jenks/Chilton, Laboratory Division <br /> Field Samole Cham of Custody Record <br /> Source of Sampla(s)eW--/5f- p1 Collector , L L L <br /> ,, ( NE <br /> 4ddress U (� // Jew <br /> � � fflliation <br /> .00 <br /> Add r e s <br /> 1 Phone ) "" <br /> RaoorT. to ( ;) ee&< Phone 6W ) 52r2-- 32 61 _ <br /> Sarisol_ En;armacian K/,]/C. foo YumoerPlJ�3L0.� <br /> iyoe <br /> Lao No . Raid No 0ata E7me (2) DeoLh Reqiar'cs (Susae.t_d Con,:. ninanzs , <br /> Fiala Conditions , ecc ) <br /> .00 <br /> } OIA/ air Z �z . Ste / /fi1'�i' - <br /> 1 Chain of Posscss ,on n L <br /> i Rel intiu i s�ne`j ��� Oal.- Time natal ved by (3) Oac-a Time <br /> 11 (Sicnazai-E 3na affilla ion) (Sianazure and of 11 iacion) <br /> 1 <br /> s1)1 111 !1,4 hki r. ) ) <br /> _� 2• I I l 1 <br /> CogaEd in az Q J/C by I I <br /> (1) � seoarata Rzguesz for Analysis form is to be tilled out by the collector and. given to <br /> j the Caocra a ry wnen samoles are delivered (2) e.g . waLar, sludge, salt , etc. (3) IF any <br /> samolas are not in-c-act at time of transfer, please describe on the bac% or this form. <br /> �3C7 batc`i of 10 or fever sam olej of eac-i maLrl-. tyoe (soil , Naze- , etc ) musz include enouC_n <br /> oT one samole for t-ialicaz, analysis. <br /> IAARPi: IG ihesa ,amoles eanzaln unknown chemicals -vnlch , +Joan analysis , may 5e ae-a—mines Lc <br /> oe "'.sown to ;-ia Sc-lca ;.a r_au:,j cancer or riaranUCrive tociclty" , under t`ie Caii ;or-iia Safe <br /> }Jrintiinfl '14tar _nc 7a-ic_ iLt IT L�26 E°-:Cosivlon 0: ) <br /> (7 ! <br /> r�C <br /> � Y <br />