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CHAIN OF CUSTODY/SAMPLE ANALYSIS REQUEST
Collector Fkmr Hado/d CootacllReooeder Tellwhous No. MUN FAX
SAP Ne. amollaa Oriel Porches Order/Clame Code
Proles Tide
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ke Ched Ne.^^S Teams.
Shhmtd To aAb) Method o(Shipmeat BBi o(Ladiaa/Alr BW No.
Protocol
CFRrIA
PLMIBLE SAMPLE KAr.ARDS/It 0llA1tK4
« « Cmwim RWmmive Maari al MOOmeotraliWl dwn eM nsx Med(or usaw"oa Per e9 CFR bie w as
releasable per DOG Otdu 34101S (1990'1997)
Priority. 45 Days
((aDe Property No,
0.C.N
I07-006-242
Pop 1 of 1
SPECIIAL LYSTRUCFIONS llold Time To ta
l Activity Excmptim: yabld No
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elmua of 1e daye
WSCR Dateh aB PtD& OW ucply arDa"ed lob me SDO, dm7yekeue.
Surpie No. Lab ID • Data Tirro WType Cmtaim Surpb A t lytir Prcravrtive
81KYMB(F) W 2t 11 WOanL 9W COLOPZTK FLD: FIemavalent 0aoralm(1)
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iwd By Sip ila
F a%&r
NOV 2 22006 V 2 . 2 2006 R _ ^dt rK - Im"Road
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rX. - rgnamllmd
Reliagriied er DdsTme ReaMved By 1>,Wlimt
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Se. - Ardre I. - Whr
W - Wrvr
1. - I1rA
Bdiogo kd By DaWTime Received By Oeb7'ene 0 - (lit
V - V. fttkm
A - Air X - (a1v
RdiKommed By D0.WT'em Rv^wetvedBy D.Wrlme
F LN LE
Dls Fosrfj Dlpoul rdcrtnd (a.P., RM
'!'y^4' W t PPN t9P(gW`SriP
eosrrlav ^J^7GL/ ^n t+^'(^J
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Matrix
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