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f'-':.C.1. InG <br />Chain of Custody Record III IIIIIIIIIIIII 111 <br />Customer: l1~"S'f~2A tttez,c ~0[.t~~2A-~OOISampler: ~nrY /-~r~~i.rS <br />Date: <br />Sample Information <br /> <br />Sample # Date Time Composite! <br />Grab Location A.~~alysis <br />Requested <br />NAO~ ~vFaq ~Z ~ ~s GK9~f3 pva0 00~ u~e'~R wa•~ -rte <br /> <br /> <br /> <br /> <br /> <br /> <br />Sample Custodv Record <br />Relinquished by: Received by: DatelTiine <br /> BPS <br />Relinquished by: Received by: Date/Time <br />GtPS ~ °- <br />Reliequished by: Recei Datelfirtte <br /> lt'~.q ~%~o ~ <br />Sample Received in Lab by telrime <br />1-8- :~ _ <br />Comments <br />Temperature Received in the Lab: <br />Effluent: 4 , o ° L <br />Receiving Water: <br />