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Inter- Mountain <br />Laboramrias, Inc. <br />CHAIN OF CUSTODY RECORD <br />CII nt/ProJect Name <br />~~~~ fDG/~/C Protect Location <br />/~,rQ~,(~~~f ~?~i,~,~ ~j/C/A ANALYSES/PARAMETERS <br />'Samples: (Signature) Chain of Custody Tape No. <br />,' ~~SY~~ <br />J ~~r~a~, <br /> <br /> <br />Sample No.l <br />Identification Date Time Lab Number Matrix <br />m <br /> <br />C ~~ <br />P <br />d o ~'~ <br />z~ ~ ~ <br />Remarks <br /> <br />. ,~l A,CQ ~ ~{ ~~ ,f r~ ~ ,ayC.~ 1 1' <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Relinquis~Jhe~d by: (Signature) <br />%is;/7-n+ - ~`-1~ /tfdC/1v~1 /loG ~.dl-llr-r /s D~ DDyate <br />" ~r- Time <br />~~'"J ~ Received by: (Signature) <br />"~ p a~,F1i~+J.it//!/G/, Date Time <br />Relinq//u/~niJsh~ed by: S~i7g'n'atu/re) /~ Date Time Received by: (Signature) _ Date Time <br />Relinquished by: Signature) 9~ `~'~~ Data Time Received laborato : (Signs re) Date Time <br />~~~v/o~ ~ ~ ~-0~ Inter-Mountain Laboratories, Inc. <br />Q ~ O Q <br />555 Absaraka 1633 Terra Avenue 1701 Phillips Circle 2506 West Main Street <br />Sheridan, Wyoming 82801 Sheridan, Wyoming 82801 Gillette, Wyoming 82718 Farmington, NM 87401 <br />Telephone (307) 674-7506 Telephone (307) 672-8945 Telephone (307) 682-8945 Telephone (505) 326-4737 <br />O <br />11183 State Hwy. 30 <br />College Station, TX 77845 <br />Telephone (979) 776-8945 <br /> <br />~~~~~ <br /> <br />