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CHAIN OF CUSTODY RECOROND ANALYSIS REQUEST S ff D Imo/ C <br /> 5500 Boscell Common Fremont, CA 94538 Tel 510 490-8571 Fax 510 490-8572 <br /> opvslr.E Project Manager ell 0-.Mo f �, ..rk Bilk to <br /> E N V I R O N M E N T A L Client Name V A5 Cr-e,-✓e-z Company <br /> LABORATORIES, INC Address 2-07-o / Wv0WwAe-V <br /> sr Address <br /> City, State ZIP S' ,rt.4 A,,.,. (�� �� ?-G v- City, State ZIP <br /> Phone 7 f 93 S Phone <br /> Date 11171q'? Fax 71Y 66 7 -7i 1/1 Fax <br /> Page r of 0% <br /> Laboratory f . -e C Pi v Project Name P 4 No <br /> Lab Number 2 F o i 6 Project Number nca <br /> Analysis Requested <br /> ii Z3 <br /> Cr <br /> W <br /> � <br /> cr <br /> E a W z z `J <br /> Sample Identiflcalion Date Sampled Time Sampled Matrix N c m a a z Remarks <br /> S— My 2FM-o I V I X N I <br /> kv - 3 55 l`� i/ 0 W / . ` b1 - 01 <br /> h01/-13- -75" //5-0 WZ714 /2-2 -03 y <br /> it N1 -r 6 `� -� / /�� Iz sy w P 12 04 X I ) <br /> r 1 - -v60�r <br /> tit t <br /> 4✓-/ - -Z 135-0 lav / <br /> 6v-�y- 66-zCPa�r c ay-0 i✓ r I yaS fzlo <br /> �- 99 I`/ i s �✓ I z� <br /> MW - IkJ - y: va --o >C <br /> YlY- Z' <br /> A iY- EPL - <br /> Initials Printed Name Signature Date Total Containers <br /> M y M- c V a Q Start Time Received Intact <br /> Stop Time Received Cold <br /> Hours Custody Seals <br /> Client Sign-off <br /> White Copv -Admin/Lab Yellow- Mobile Lab Pink - Client <br />