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f. •g. <br /> CLIENT CHAIN OF CUSTODY RECORD <br /> NAME:CKN ZOIC . REQUEST FO ANALYSIS C K Y incorporated <br /> ADDRESS: 3µ O Ia Y>'Cw.v�.C1+— RIVd „ - I /Ub DATE: 8I3G QS Analytical laboratorfes :"'- <br /> 630 Maple Ave. <br /> -T-61 Y A 9a,�-33 PAGE I OF Torrance,Calif.90503 <br /> PHONE NO 316 7--372$ FAX NO.(31 GYP 2 -372�216 7T��� ��// ,,,,,� Tel: 310-618-8889 . . _.,. <br /> PROJECTNAME: TYA CN f1-uXt��� -f i+l Pri^( iP1c� i-r �/ync.AP�9N D -00/Z� Det'v"o1rAgt- 44 60 Fax: 310-618-0818 <br /> SEND REPORT TO nP �t ti /YIC -1a I(�'`7 R'• N. S. 5322-a`eP " dl's <br /> TURNAROUND TIME ANALYSES RBOUIRED <br /> SAMPLER NAME/SIGNATURE NORMAL J4 _ R <br /> ��n��{�n� /) 6 g� y �r <br /> I aka- I/l I���it� ✓UAt l� U RUSH v $ OS to <br /> SAMPLE SAMPLING PRESER- CO AINER SAMPLE DESCRIPTION ai $ � Pv � S N Sa p1 z <br /> NUMBER DATE/TIME NATIVE SIZE/TYPE WATER SOIL OTHERyz <br /> DUOUSr-CQ- W I 2�5 GS 1:s5 — z"� 6e )( X X <br /> Z Saco <br /> 330od U51- -E6- miD a.65 — X X <br /> mod dsr-15B - fr 2'/s — X X X <br /> T 59-•CAST—N IFRet, :ZS — X X X X <br /> 6 9`a'-ncR-ty- 2' 1N 2;W — X X X <br /> 7 SP-wEsl - z' fr 2•yo <br /> 1%tN X k x )( <br /> X x x <br /> + +eaM f L <br /> COMMENTS: <br /> you <br /> Relinquished b SD e: b n re) Dai q Relinquished by: (Signature) Date: Received by: (Signature) Date: <br /> Company: Time: Company: Time: Company: Time: Company: Time: <br /> C Lv1� .£N�'1 semi 9; ro/tr" C° <br /> .';Storage/Disposal of Samples: Sample will be stored at CKY for 30 days at no charge and at$10/sample/month thereafter. Disposal of sample by the Laboratory will be charged at$10/sample. <br /> I <br />