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wM <br /> 0277 <br /> Du Pont Environmental Remediation Services <br /> CHAIN OIC CUSTODY RECORD <br /> 7068 Koll Centcr Parkway,Suite 401, I'leasuttton,California 94S66, (415) 462-7772 <br /> r.a <br /> Testing!.:thorat(ryL_/ f-4c C° A,iy,� S_ _ Phone Number: <br /> 1' Address: _ <br /> City,Staie,lin: <br /> t a PUIZCHASE ORDER NO, <br /> PROJECT'NAME: ANALYSIS <br /> SITE LOCATION: <br /> JOB NUMBER: <br /> REOUESTOR: <br /> .a SAMPLER'S SIGNATURE: <br /> - € T &-affix A.4TE.- 77HE COMP G LOCATIONS, - NO.OF S4AfPLr 1_' 1�� R AMRXS <br /> I ID. I�e1 � CC'. TALVERS TYPE <br /> i 36-I <br /> `l r f, V --2 [-_)r -FA 7- <br /> J,, <br /> - <br /> ' 1� <br /> -6 1, �: 2 TA 7- <br /> 16-y " ,, 1 t, 2 7 A7� <br /> )� , �, ! ✓ ✓ N—.1 i SIT' <br /> RELINQ HED-13Y ( ' ature) DATE RECEIVED BY:(Signature) DATE <br /> TIME TIME <br /> R R G: h0,4 REPRESENTING: <br /> ELINOUISHED BY:(Signature) DATE RECEIVED BY:(Signature) DATE <br /> TIME TIME <br /> ( . REPRESENTING: REPRESENTING: <br /> 1 RELINOUISHED BY:(Signature) DATE RED BY,(Signature) DATE <br /> - --- ---- <br /> TIME - - TIME, <br /> REPRESENTING: REPRESENTING: Vt.. <br /> METHODOFSHIPMENT: Pi<� - up 5; rA i,C <br /> .2-,1 rX t 1.:•- 1, T11T. / ism y--9 �Z� C-21 <br /> WItrT'i?.•ReturntoClientwithReport. YELLOW;IaboratoryCupy. PINY:ariginator'aCopy <br />