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.... <br /> i <br /> Boa= Eff <br /> w <br /> F- CRAXW — OF — CUSTODY REC0RD <br /> E <br /> SAMPLER: (Signature) <br /> h Data Sampled Qr— S—$g Dete Shipped �t—�—fig Carrier ' � <br /> SHIP TO: SEND RESULTS TO: <br /> 1 - <br /> Mr. Chih-Sen Ho Nr. Philip L. Chang <br /> t=+ Eureka Laboratories, Inc. Balbi L Chang Associates <br /> 3401 La Grande Boulevard 151 Link Road, Suite A <br /> t Sacramento, California 95823 Cordelia, California 94585 <br /> w (916) 428 1193 (707) 864 2020 <br /> PROJECT NAME 7gIG•K PROJ N0. <br /> l A _ <br /> P inquis d by: (Signature) cieved by: (Signatur ) D e Time <br /> Relinquished by: (Signature) Recieved by: (Signature) Date Time <br /> ANALYSIS REQUESTED <br /> Sample ID Sample Date/Time Analysis Requested Sampled Condition <br /> Number Description Sampled. Upon Reciept <br /> Special Instructicns/Comments: <br /> C <br />