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VEOLIA SAMPLE SHIPPING DOCUMENT/ Number <br /> ENVIRONMENTAL SERVICES CHAIN OF CUSTODY Page of <br /> Veolia ES Technical Solutions, L.L.C. Client _ . . 31-1 SIE. PYIZ <br /> Shipping Information an tr 4 fo 0 �Z <br /> Proper Shipping Name #Units Total Quantity <br /> ATTN: 1 etnv+ wt <br /> LaboratoryContact 7a>rw t Bel In <br /> e.....- �� �,���IC-�'t Name <br /> NO.OF SAMPLE CONTAINERS <br /> I hereby declare that the contents of this consignment are fully and accurately <br /> described above by the proper shipping name, and are classified, packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for trans- <br /> port according to all applicable international and national governmental regulations. <br /> n o <br /> IN CASE OF EMERGENCY CALL 1-877-818-0087 ca5 c�� vn`� �°^ <br /> Project Description WIP# °FQ°° n�G ��.0 <br /> m m <br /> Nv ReportingType: NJ Re Format,NJ Reduced Format, <br /> yp 9 TAT: 1 wk,2 wk,s wk \° �.� �m \no QJ ,Q y ti <br /> co CLP,Level II,Level I([Data Sum), Other \� \a �y �° � � `� o Q .a ic° �Q <br /> Other �° m� 6` Q� 0� c �o p <br /> SAMPLE LOCATION DATE TIME SAMPLE NUMSES <br /> aMiuiary) <br /> i'a ! S� K t 1 <br /> s� x <br /> Lbbtl�q C. <br /> bo12 D Will �� X <br /> Time Time Time Time <br /> ReRinquished by(signature): Date ;1Ad,13ry1 R Zt, Date W raaryi rReaishedby gna e]: Date tom; a,y, Receivetl by(Signature} Date rM trra y} <br /> 7'50 WYAA <br /> � /��, �I SD <br /> Time Time <br /> NRei7quie gnature): Date �M'Waly> Received by(Signature) Date ;M."jcoend Results to Veolia ES Technical Solutions, L.L.C. <br /> tr/f4 (foo �` �` <br /> 1 /�'g 00 VIA: Verbal ❑ Fax❑ Fed X❑ Regular❑ <br /> — 4�� — 06 <br /> 10 REMARKS' i Purchase Order# Work Order# <br /> 13/1,0 Z �3 c. <br /> 12 <br /> 57!? gS12— [e .N 'Y?i"`t` i:f& Y Form R VES <br /> R ® �i �7Aeeee © !� © © D <br />