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AANALYTICA 325 Interlocken Parkway. Suite 200 <br /> EN V I RON M EN TA L Broomfield, Colorado BW21 <br /> LABORATORIES (303) 469-8868 or 1-800-873-6707 <br /> CHAIN OF CUSTODY RECORD FAX: (303) 469-5254 <br /> CLIENT NAME CLIENT CONTACT ANALYTICA <br /> USE ONLY 0 <br /> 717. <br /> CLIENT ADDRESS PROJECT ID/DESCRIPTION <br /> F CSN <br /> TELEPHONE " , <br /> i <br /> LGN <br /> FAX ). P.O. NO. TESTS REQUESTED <br /> LOC gZ2,� <br /> Sample Matrix (Circle one) <br /> WATER SOIL OIL SLUDGE No QC J <br /> OTHER (specify) OF <br /> (NOTE: use one Chain of Custody per matrix) BOTTLES C ty PM <br /> t- � <br /> DATE TIME CLIENT ID DUE 2- <br /> f �� <br /> L <br /> t <br /> COMMENTS -• MEANS OF DELIVERY <br /> RELINQUISHED BY DATEMME RECEIVED BY DATEITIME RELINQUISHED BY DATE/TIME RECEIVED BY DATE/TIME <br /> 0030294 <br />