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Chain of Custody Record Purchase Order Number] <br />r(s'eaCrestGrouo <br />AN ENVIRONMENTAL SERVICES COMPANY (enclose with each shipping container) <br />1341 Cannon Street • Louisville, CO 80027 <br />303.661.9324 303.661.9325 fax • www.seacrestgroup. Project Number Qab use only) <br />Client: Contact: 1-aAslAze- Address: f d rSoX 17S-0 <br />- 42 -Xi-0 G? <br />Program/Site: Phone: I7'19-Z75'-7 E q v°N ` 0r tCj l FS <br />Collected by: J?o ?iQi??? ?/ Acute Chronic <br />3 3 a <br />Sample Vo . C Date /,T,/ 4 v c 4 Total Total <br />Sample Identification Type 110 ,= u ?r Q?r (l?Ikc `??I m? <br /> <br /> <br />1 Effluent, ReceNin , Sediment, est otne <br /> <br />DC'S 00/ - .a.... N?caa <br /> <br />/A-A7 <br />r?,r <br />$.s? co osue, MO <br /> <br />.. e <br />k <br />X - - -- - - <br />:? - - - <br />2 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />V <br />Comments and special testing instructions: Spy -A 2Tq c- A,,,\ e, T D ? 7 a 6 <br />n <br />Relinquished by: )3o? ???'??^- Representing: s e' -p To Whom: Tx Jac Cvt's??rrovate?me: <br />Relinquished by: Representing: To Whom:. -- Date/Time: <br />Next recipient: _ Relinquished by: Rec'd by: -?? ?- Date/Time: Z <br />WHITE COPY: Accompanies samples CANARY COP :Client