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SAMPLE CHAT OF CUSTODY <br /> Date <br /> ho19'd Remedy, Inc. <br /> 112 Dove Court <br /> r l Vacaville, CA 95887 <br /> Protect Name r��l�C� Telephone (707) 451-8598 <br /> Project Number Laboratory Fax {707} 451-859$ <br /> Report Results To Name �-e <br /> Sampler Name CW"/7Qi!lQidl Address <br /> Turn Around Time Telephone Fax <br /> ANALYSIS REQUESTED <br /> SAMPLE DATE TIME LOCATION SAMPLE T N #! ��Y ,g)� COMMENTS-DESCRIPTION-SPECIAL INSTRUCTIONS <br /> NUMBER TYPE t7 y` rl <br /> ~�D <br /> Pal-) for ell, os t l <br /> t J� ,rr '?,i' rJ „ X <br /> l <br /> r K/1 �/ <br /> (r x <br /> Fr- k o Z rr 3b rJ r/ h <br /> Y- /J-3-7101A Wfe, <br /> SAMPLE RELINQUISHED BY SAMPLE RECEIVED BY <br /> Print Name i nature Date Time Print Name Signature pate Time <br />