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® RIEDEL ENVIRONMENTALChain of Custody `°b"°`°` 4 y: .)PLaDate: <br /> lLe T�RaZ•StoN 12'F� <br /> ��, <br /> �� <br /> o SERVICES, INC A Contact: — Page: <br /> 4138 Lakeside Drive, Richmond. California 94806 Request for Analysis 22� �tJ\t Ofo I <br /> Phone: (510) 222-7BIO Fav: (510) 222-6868 Phone: <br /> PROJECT INFORMATION ANALYSES CONTAINERS <br /> Project Manager: Gi}2l$ l.�l+r'1t Project Name: <br /> ('- 7l) I22' 4xY `JSDC,KsTJN m N E <br /> Fax Results to: Al: c <br /> _ llx''( n o� z E <br /> u!0 <br /> VYl 1-a� 4 Ur P <br /> Also to: Al: .- Project d -- ,.o ., <br /> A I11'a 'a ci N Yi'e L <br /> x{�'xl ' c"h P.O. lr1dL \\ L]aY i? X00 Yo as a„ Y o 3 <br /> Send Report to: N e ,in a w ua a- <br /> Sample Team (grin C rIRxS I'll-Y)-Q TT CVwz\S -'i?�TY '° e' c oo u�. o ur ya uw n ° <br /> Y� n Y\ EN o� !-aa w + a� .� n' u u c <br /> f• �m �\ 00 om o0 n� �u• um ua Urp n1p <br /> ^O uo Yn ¢ Z� m Y\ .1ci ao d o` o c� b n <br /> ai nat0(G! ^� ~� �M CI^ Y YlV Y� O> U'n N UQ U. " ° <br /> ( 9 ) N M la oW oO Ye bb OY�1 1r0 H° j ° .a.. u ° <br /> ffi <br /> Turn Around Time: 10 Day 5 Day 48 Hr. 4 Hr.�' Other 1 ¢ I a x ma o•ap a 'a c a o° a u s a <br /> xa xa a__ a a a Ea a <br /> Somple ID Lab ID Dale Time Matrix Preserv. a� aaW 'w �w ow Yw aw aX �o aY °Yo "u <br /> F Fv FO a.. av >� VI... 18w 1-I fF Ur JF Wf <br /> 3D So I c- <br /> — X <br /> MGM <br /> SPECIAL INSTRUCTIONS / COMMENTS: _ RELINQUISHED BY (Sampler): RELINQUISHED 111. RELINOII° Y: SAMPLL 1111:1.11'1 <br /> n12 Total No. Containers <br /> (Slgnoiu,•) rinr (Signature) (r1m.) (Signator.) <br /> [oltL) -- <br /> 74 Tta- -T PI (Printed Nag•) ID ) (PUnled Nome (Dob) (Printed Nome) (D•1.) —_ <br /> R-�ta�r Head Space <br /> (C.P.Y) (C Pant) (C.Po•Y) <br /> Y N <br /> RECEIVED BY: RECEIVED BY: EIVED Recti Good Cond/Codd <br /> 0 L 1 T'a 1I �( x, (Synaluw) (I4n•) (Signowre) -- Ulrn•) (Slgnolu ) (Tim•) Y N <br /> / (PrMled Nyme (Do1n) (P,Inlwl Name) / (0ab) (PrMled Nome) p ( P ) Conforms to Record <br /> (C-F-Y) (ComPanY) / "(cm -Y) yam( Y N <br />