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HEGION VIII,ONE DENVER PLACE <br /> 99918TH.STREET <br /> Environmental Services Division CHAIN OF CUSTODY RECORD DENVER,CO.80202.2413 <br /> PROJ.NO. PROJECT NAME <br /> / <br /> ,.'���i i , . ,.•/ /, %/� ;7. ;�',% ;• it '; \, (�: <br /> NO. <br /> SAMPLERS:(Signature) <br /> OF <br /> �I �_ REMARKS <br /> % 1% CON. c2 7 <br /> TAINERS <br /> STAT.NO. DATE TIME o STATION LOCATION <br /> 71( <br /> l <br /> , I <br /> J ' <br /> �14 <br /> ✓ /r=ff' ,r - �✓— /t% �I I ✓ 1 :.' '� / - <br /> � ( ' /►�11�'�a r)�lw ('tjt.')(,r <br /> Relinquished by:(Signature) Daterrime Received by:(Signature) Relinquished by:(Signature) Daterrime Received by:(Signature <br /> Relinquished by:(Signature) Daterrime Received by:(Signature) Relinquished by:(Signature) DaterTime Received by:(Signa►urt <br /> Relinquished by:(Signature) Daterrime Received for Laboratory by: Date/Time Remarks - <br /> (Signature) <br /> Distribution:Original Accompanies Shipment:First Copy to Coordinator Field Files:Second Copy to Representative of Inspected Facility Split Samples: <br /> RR FPAd114R r4-91.AF, <br />