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ACTIChain of Custody Record Date: / /3� <br /> Analytical ChemTech Pager of <br /> International, Inc. yy Billing Information: <br /> Company Name: /x� Company Name: <br /> 4011 Power Inn Rd. , <br /> Sacramento, CA 95826 Address: Address: <br /> City, State, Zip: City, State, Zip: : <br /> Phone: (916) 455-2284 } , <br /> FAX: (916) 455-0191 Telephone: Telephone: <br /> FAX: FAX: <br /> Project Name: Report Attn: Contact: <br /> Project J/: <br /> Contact: G f f T <br /> P.O. i/: <br /> Control Check`: <br /> • Sample Date Time Sample Tests N of Sampling Remarks (include Number one <br /> Identification Sampled Sampled Location/ Required Jars Method type & appearance) Lab Use <br /> Position Only F P.•• <br /> =ice <br /> 1610 ellr,i P T <;f 47-41, C'Z J/T 4/eTZ <br /> 9M ' <br /> =PC IyU <br /> Total Number of Containers: R sampler's signature: ff / F:FIIW4 <br /> l/ �r.r (icy <br /> P:P, <br /> Relin jehed by: Company Relinquished by: Company Relinquished by: Company ,.K <br /> Received by: Company Received by: CompanyRace' d by pa Company ."Z r r <br /> /-:. <br /> Date I me / Temp (*Cl Date I Time Tamp PCI Date /TI e� Temp PCI <br /> /3 Atm // T, <br /> -�« <br /> Distribution: White, Canary - Laboratory Pink - Originator NOTE:Samples are discarded 30 days after results are reported unless other arrangements are ma4ar, <br />