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<br />CHAIN-OF-CUSTODY F III IIIIIIIIIIIII III BEQUEST FOR ANALYSIS 2159 3 <br />MC(.uLLtY, rKwn a vrLMAN, INC. COC No. <br />^ Auslin OH¢e ^ Boston Oflir< ~BOUIGer Orcca ^ Missoula Ofliu ^ OsDUm ORCe ^ San FiancisCA 09o;e ^ Beallle Olfce <br />8900 Business Park Dr 444 Washington SI p504 4900 Pearl E. Circle p300W 215 5 3" 51 West 809 E. Mullen Avenue T1 Slevensan SI. p1450 19203 36' Avenue W 0101 <br />Auslin. T% ]B]59 Woburn, MA 01001 BoulCer, CO 60301 Missoula. MT 59801 Osburn, ID 83849 Ban Francesco, CA 94105 Lynnwoo0. WA 98036 <br />TEL (512) 33&166] TEL' 1]81) 93]-0SLb iEL 1303) m]-1823 TEL (4061 ]2B<600 TEL (20615566811 TEL 1415) 495-]110 TEL (4251 ]]BA252 <br />FA% (517)338-1331 Fq%~(]61)93]-05]8 FA%'1303)44]~1836 FA% Id06)]26<696 FM (206)556-]271 FA% (4151495-]t0] FAX'(4251 ]]16841 <br />PROJECT NO.: ~~ JECT NAME: ~'~ Q-C~ ~c^L~ <br />SAMPLER (Signature}: PROJECT MANAGER: (A <br /> <br />METHOD OF SHIPMEN CARRIER/WAYBILL NO.: <br />I~lV I~ ~{~ILM\tl ~/\.\PLI~.1C I_PAGE: <br />-P-~: Ok,'FsJ /~~ SiMP5o1~DATE: <br />,. <br />DESTINATION: t~AZF~J ~OF:`_ <br />1a~3o/ S8 <br />---r <br />LASS <br /> SAMPLES ANALYSIS REQUEST <br /> Sample Preservation Containers ConstituentsiMethod Handling Remarks <br /> <br /> <br /> <br />ab <br />No. <br /> <br />Field <br />Sample <br />Identification <br /> <br /> <br /> <br />ATE <br /> <br /> <br /> <br />IME <br /> <br /> <br />;, <br />~ <br /> <br />_ <br />~ <br />_ <br /> <br />O <br /> <br />_ <br /> <br />~ <br /> <br />= <br /> <br />~ <br /> <br />o z <br />~ <br />a <br />~ <br />~ <br />w <br />~ N <br />~ ~ <br />O E <br /> <br />a <br /> <br />F <br /> <br /> <br />z <br /> <br />~ <br /> <br />o <br /> <br /> <br />i <br />~ ~ <br />~ <br />o <br /> <br />~ <br /> TAtLI].~S bNr~ 9 43a ~ 3 3 1 P 3 ~ SEE AnACtikE,D <br /> ~I ..~ ti=5 MINE 2 .3 3 3 ST t\5T <br /> wF ~~ ~ t +>t z 3 3 3 \-r <br /> 4,~t~ ~ ~a z 3 3 3 <br /> wEt~ ~ 2 2 3 j <br /> .NEL-~ # 3 2 3 3 3 <br /> w E t.L i~ y 2 3 3 <br /> Z A1S\T 2 3 3 <br /> ~ -r ~p C.2 2 3 3 3 <br /> <br /> <br />..::.......:.. <br />~' ~ ~' "" ~ <br />:.. .. <br /> <br /> <br />.:'~:'.'. ~.:. OTAL MB ON BOMTORY COMMENT6ICONOITON OF 6AMPLE9 <br /> <br /> <br />mp: <br />RELINQUISHED BY: RECEIVED BY: <br />SIGNATUR PRINTED NAME COMPANY DATE TIME SIGNATURE PRINTED NAME COMPANY <br /> 4_E.SIr•~ 6 3 q 3 S grf~A-w10 S <br /> <br /> <br /> <br />'I(EY MNm AO - pueoui NA ~ MnaTye4a5 50 ~ iod SL ~ fl~rtlye P ~ pehokum A - ev Oi ~ cMn CoNmria'f' p ~ p~axtc G -peace T ~ hlbn B - baaa Or ~ dlr Fibalun F ~ MxaC U- wNnea <br />OISTFIBITOM: pINN Fed LOpy YEIIOW. LeMelpry Copy 4NIIrE. Relu'nbgyrula <br />'~ <br />J <br /> <br />