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ANALYTICA 325 Interlocken Parkway, Suite 200 <br /> ENVIRONMENTAL Broomfield, Colorado 80021 <br /> LABORATORIES (303)469-8868 or <br /> CHAIN OF CUSTODY RECORD FAX (303)469-53-8707 54 <br /> CLIENT NAME CLIENT CONTACT ANALYTICA <br /> USE ONLY <br /> CLIENT ADDRESS PROJECT ID/DESCRIPTION <br /> t CSN <br /> TELEPHONE <br /> LGN <br /> FAX P.O.NO TESTS REQUESTED <br /> LOC <br /> Sample Matrix (circle one) <br /> WATER SOIL OIL SLUDGE QC <br /> NO. <br /> OTHER (specify) OF <br /> BOTTLES *' PM <br /> (NOTE: use one Chain of Custody per matrix) <br /> DATE TIME CLIENT ID DUE <br /> r � � <br /> COMMENTS i e { MEANS OF DELIVERY <br /> RELINQUISHED BY DATE/TIME RECEIVED BY DATEMME RELINQUISHED BY DATE/TIME RECEIVED BY DATE/TIME <br /> r, r <br /> 003-0294 <br />