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M90137e <br />......._ ..... <br />Lab I.D. <br />Project Number. c9r <br />Sampler: (Pmt Paine) FMt II.uo,c f 4 <br />Truji f o <br />Reid Semple No) <br />Identification <br />Relinquished by: (Prim Nome) <br />Signature: <br />Relinquished by: (Pmt Name) <br />Signature: <br />Date: <br />Project Local <br />ESt CC <br />Signature: <br />Signature: <br />CHAIN OF CUSTODY RECORD <br />Field Logbook No.: <br />Chain or Custody Tape No.: 3298 <br />Send Results/Report to: Falcon Price <br />P.O. Box 1080 Kellogg, ID 838 <br />Received by (Print Nerve) <br />Received by: (Print Name) <br />Date: <br />Time: <br />Dale: <br />Time: <br />Analysis Requested <br />Relinquished by: (Print Nam) <br />Signature: <br />Date: <br />Time: <br />Received by: TV Name) <br />57:N CS <br />Signature: J! <br />c <br />Date: <br />09/77 <br />Time: itto <br />Analytical Laboratory (Destination): <br />ENSR Labs <br />Fort Collins, CO 80521 <br />0 rR : �✓� X as IOC.. C?_ 7 t... i"kgyit 3 <br />Serial No 18701 <br />