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/A� Chain of Custody Record Date: <br /> ���I Page:�� of 3 <br /> Analytical ChemTech ��� Billing Information: <br /> International, Inc. <br /> Company Name: <br /> Company Name: <br /> 4011 Power Inn Rd. i 1997 Address: <br /> Address: <br /> Sacramento, CA 95826 <br /> City, State, Zip: <br /> City, State, Zip: OLP+ <br /> Phone: (916) 455-2284 Telephone: +CP SCRVI, Telephone: <br /> FAX: (916) 455-0191 FAX: FAX: <br /> Report Attn: Contact: <br /> Project Name: --:t <br /> .-<ar <br /> Project #: P.O. #: <br /> Contact: <br /> Control Chemo'. <br /> Sample Remarks (include Number O°e'"" <br /> Sample Date Time Tests # of Sampling Location/ & <br /> Lab Use <br /> Identification Sampled S <br /> Method type appearance) <br /> ampled Required Jars Onl F <br /> Position y <br /> I <br /> _ t _ <br /> i <br /> W.- <br /> r <br /> F FMrwl+,r <br /> Total Number of Containers: 14 <br /> Sampler's Signature: i P PrerrvidY <br /> Company <br /> Relinquished by: Company Relinquished by: i <br /> Relinquished by: Company <br /> Received Li... v Company <br /> y a <br /> Company Received by: Company {y. <br /> Received by: „ y <br /> Temp (°C) Date /Time Tamp rC <br /> Date/Time Temp PC) Date I Time <br /> ' NOTE: Samples are discarded 30 days after results are reported unless other arrangements are made <br /> Distribution: White, Canary - Laboratory Pink - Originator . <br />