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CHAIN-OF-CUSTODY RECORD <br /> . `j <br /> 22552 <br /> No. <br /> INDUSTRIAL COMPLIANCE - 9838 OLD PLACERVILLE ROAD, SUITE 100 • SACRAMENTO, CA 95827-3559 <br /> Phone 916-36 971 FAX 918-369-8370 <br /> PROJECT NAME PROJECT LOCATION <br /> 5 0 k w ' aao., ANALYSIS DESIRED <br /> A-+►�`L Car <br /> PROJ.NO. PROJECT CONTACT PROJECT TELEPHONE <br /> NO. t CATE <br /> or SEPARATE ' <br /> IRA +,y A t-� R <br /> .Ie T� 0%\6 - 31Q Q Z CONTAINERS) <br /> CLIENTS REPRESENTATIVE PROJECT MANAGER/SUPERVISOR Co N , 1 <br /> GIC'G r1e-,v� 11�Y>C hi..-�.�c E\ _o 0 ,'b�� �^' ei► i <br /> z SAMPLE SAMPLE LOCATION O <br /> DATE TIME ( POINT OF SAMPLE) <br /> INCLUDE MATRIX AND <br /> uj NUMBER <br /> � (1 t <br /> 1 REMARKS <br /> M'L45 W q�rt r <br /> )stis �. S» -oz 0 Z 3 3 <br /> s -O tHP� �,,oU �( •• %% <br /> I .� •, s3 -0 10 Z 3 3 <br /> 4 <br /> 5 <br /> 8 <br /> 7 <br /> 101 <br /> ITEM TRANSFERS TRANSFERS REMARKS1 D <br /> NUMBER RELINOUISHED BY ACCEPTED BY DATE TIME <br /> 2 <br /> 3 �L-�CZc.(JCcQ� �Lc-L �Cllyea�ch07�- iG V -z <br /> r7l <br /> PLER'S NAME SAMPLER'S SIG TURE <br /> L4 J F <br /> LAB COPY <br />