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Work Authorization No. 27374 00 Chairs of Custody Page 1 of 1 <br /> ARCO Facility No City,State(F NTEdifty) Project Manager(consultant) Project No (Consultant) Laboratory Name <br /> os020 MANTEc cA Ru Benkos 077 43345 Oso <br /> ARCO Engineer ARCO Telephone No uoia <br /> Paul 5u le p Telephone No (consultant) Fax No (Consultant) Global ID <br /> 51 b 299 8891 9168610400 <br /> Consultant company Consultant Address 916 861 0430 T06067700873 <br /> SECOR-SIRC 3017 Kilgore Rd, 100,Rancho Cordova,CA 95670 Method of Shipment <br /> Matrix Prsv. <br /> a Special Detection <br /> a w UmitlReporting <br /> Q � <br /> Um <br /> r E H <br /> 4 0 -0 o <br /> 0Z <br /> S <br /> to a } aayn <br /> m <br /> m W Q C <br /> o o O = aK E <br /> m E E Ur <br /> J z c`sn cn LL <br /> DU 6 x xxyla�'C'f <br /> x x x 110 special c�Arcic <br /> Mw-s x x 350 x x x <br /> MW-7 10 <br /> Af Sub'd COC Attch'd <br /> MW-8 X X0 X X X <br /> MW-9 10 <br /> X X //% X X X f0 <br /> MW-10 �"a g X X X <br /> X 10 x <br /> T&1 x V1)-;V-e4 Iraf) x x <br /> 10 <br /> Q <br /> X <br /> Sample Received Intact: Yes No Temperature received Ice <br /> No ice <br /> Relinq by s pler(Sign Print Name) D to Time Re ived by(Sign&Print Name) <br /> Lab Work No <br /> I q is <br /> Ti qVc <br /> k q shed byD Time ry Date Time <br /> Rev 11f29195 <br /> 1 i <br />