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LO NT 2749 N° 0784 <br /> Du Pont Environmental Remediation Services <br /> CHAIN-OF-CUSTODY RECORD <br /> 7068 Koll Center Parkway, Suite 401, Pleasanton, California 94566, (510) 462-7772 <br /> Testing Laborata / c'c Phone Number i Y'7' - �r <br /> Address -31/- ,7,,3 L li <br /> City, State, Zip <br /> PURCHASE ORDER NO <br /> PROJECT NAME: 'L`�'/v e e 0ANALYSIS <br /> SITE LOCATION ` -C O <br /> JOB NUMBER S <br /> REQUESTOR E- <br /> SAMPLER'S SIGNATURES <br /> 1 <br /> SAMPLE LATE TIME COMP GRAB LOG TIONS NO OF SAMPLE � REMARKS <br /> LD CONTAINERS TYPE <br /> T 7 /0:0 0 T x12Y ZZA S r Z' <br /> RELINQUISHED BY (Signature) DATE RECEIVED BY (Signature) DA E <br /> Q -2 <br /> I E TIM , <br /> REPRESENTING G '6'0 6 REPRESENTING dv <br /> R7 UESHED BY (Stgnat re) DRECEIVED BY (Signature) L DAT7, Irn �l <br /> % <br /> ;Wlaa 2 1 <br /> TIME `)r,"It A�al TIME W, <br /> REPRESENTING •` �, REPRESENTING It <br /> RELINQUISHED BY (Signature) DATE RECEIVED BY (Signature) DATE <br /> TIME TIME <br /> 6REPRESENTING REPRESENTING <br /> METHOD OF SHIPMENT Ya hr <br /> C� �,G3ay ect <br /> WIIrM Return to Client with Report YELLOW LaboratoryCopy PINY,Originator's Copy <br /> �7� "ay-r.4 r), A-6 <br />