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fflonew, ^�N RFCATOD"EMD ENS-1145-A DATE CHAIN OF CUSTODY NUMBER <br /> 19842❑2544 Industrial Ave.,West Sacramento,CA.95691-3435(916)372-1393 f-/—/1Z— G S <br /> A Coming Com ❑7440 Lincoln Way,Garden Grove,CA.92641-1432(714)898-6370 LAB NUMBER <br /> g pan y ❑18501 East Gale Ave.,City of Industry,CA.91748-1321(818)965-1006 / <br /> El Mobile Labs,1(800)ENSECO-8 Page O} <br /> CLIENTPROJEC T MANAGER 1 , ANALYSES <br /> 4)(-2 - /' `ill ,< ✓ I d,4 i T 6 <br /> ADDRESS TELEPHONE NUMBER(AREA CODE) <br /> CITY STATE ZIP CODE SITE CONTACT r, <br /> r� 4\ <br /> ii f`i;'/f�)'C�r l J � / <br /> TELEP <br /> PROJECT NAME HONE NUMBER(AREA CODE) v `� <br /> CONTRACT/PU CHASE ORDER/QUOTE NO. l`� 7AT <br /> 6. i3[-7 c j r! til\ J <br /> SAMPLE TYPE O.OF <br /> N <br /> SAMPLE NO./IDENTIFICATION DATE TIME LAB/SAMPLE CON- Sample Condition/ <br /> NUMBERLIQ. AIR SOLID TAINERS REMARKS <br /> o.LJI Ixs <br /> DO THE SAMPLE(S)POSE ANY POTENTIAL HAZARD(S)?IF YES,PLEASE EXPLAIN <br /> SAMPLERS(SIGNATURE) RELINQUISHED BY(SIGNATURE) RELINQUISHED BY(SIGNATURE) DAT6y TIME The delivery of samples and the signature on this chain of <br /> custody form constitutes authorization to perform the analy- <br /> RECEIVED BY(SIGNATURE) DATE TIME RECEIVED BY(SIGNATURE) DATE TIME ses specified above under the Enseco Terms and Conditions, <br /> unless a contract or purchase order has been executed and <br /> is sited above. <br /> RECEIVED FOR LABORATORY B� DATE TIME DATE TIME SAMPLE DESPOSITION: <br /> RECEIVED ACCEPTED <br /> .- 1.Storage time requested: days <br /> METHOD of SHIPMENT (Samples will be stored for thirty(30) days without additional <br /> charge; thereafter storage charges will be billed at the pub- <br /> lished rates.) <br /> SPECIAL INSTRUCTIONS PRIVILEGED AND CONFIDENTIAL 2. Sample-to be returned to client: ❑Yes ❑No (Enseco will <br /> PRIFIRARED AT REQUEST OF COUNSLI: dispose of unreturned samples for a charge of $15.00. Dis- <br /> posal will be by incineration wherever possible; otherwise, as <br /> appropriate, according to legal requirements.) <br /> DISTRIBUTION:WHITE-With Report;CANARY-To ENSECO;PINK-To Courier;GOLDENROD-To Sample Control <br />