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Kennedy/Jenks/Chilton, Laboratory Division <br /> Field S_a_mole Chain of Custody Record <br /> Source of Samples -- / Cf/ Collector 1vdvg �wl <br /> Address" sT Affiliation eNW AcS .vr <br /> mryi <br /> 4� Ta/✓ <br /> Add ress ,(�y ,yJ � i�f/d <br /> 3�� <br /> Phone (9/6 l GZ— 2S/ 5,e¢ /tM/�la <br /> Report to (1) /t / Phone <br /> i <br /> Sar:ala Infor„�at7on K/J/C Jaa Yumoer-AgaSA.00 <br /> 'Tyoe �- .. <br /> Lao Yo . Field No . Data Time (2) Deoth Remar' s (Susaected Contaminants, <br /> Field Conditions, etc.) <br /> �� -y - .' �.� s f .�- G.v <br /> q <br /> 405 -/ q. 50 S Sri dekP 5—e- In! <br /> $ c� <br /> AzarCnaTn o� ?ossassien <br /> Rel i nau i sne_ oy 176L I i n1E Rac=i ved by (3) Gaza Time <br /> (Signa- rs "na ITai.T anc affiliacTfln) <br /> Laaaed fn at_ C/J/C b•.v 1 I <br /> (I) A separate Ra;uest For AnaTysis favi Ts to be fiTTed out by the colTec'.or ana Give-r to <br /> the Laboratory wnei samoTes are deUvered. (Z) e.g. waztir,, sludge, sail , mac- (3) If any <br /> SamoTes are nor- fntac-- at time of trins-far, describe on tie bac( of form. <br /> E-acl dazci of IO or ;awer samoT as a i each md%rT Y tyre (sai T , Yaia-, a:_.) mus-: [ncl uoe enaugh <br /> of one samale for t�-iolicata analysis. <br /> RM:AG T nese sar i as cznza-L n unknown cne i i ca i s«, a tvni c-i , uoan analysis , may be a°=_z-nines za <br /> ce � - - <br /> naMn ca Scare to ca:c,e c�nc=r or recr�auc_z�re �aYzci�� _�" , unae- _�,e C,.ti ,�-or;za 5a-e <br /> (]rz„<T,yc 'ox-c_ me^i -1 !9E6 <br /> J <br />