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EXXON COMPANY, U.S A. j �4 <br /> PO Ekox 44 S 5 Houston TX -172104415 <br /> C e p P If p A { E e <br /> CHAIN OF CUSTODY <br /> Consultant Name !` t S /1 LCi/i✓Ero <br /> [� Novato, CA Ai O :etc w 5vr G Z�5 <br /> 11 Digital Drive 94949 an, Contact 'lt °� l Pr�tecis _ofy-ol-�f <br /> (415)ti83 6100 Phono Et S' (� 56 Fax# <br /> ❑ inline CA Consultant Work Release s C¢� <br /> Alton Business Park J t� <br /> 30 Hughes��tS,Suite 206 92718 °.Exxon Contac y��-q{'3.2 Phone <br /> Site RAS#-�33 U <br /> Site Locabon 117-S <br /> Laboratory Work Release i <br /> by(please print) SOIL WATER p <br /> Sa er Signature D to Sampled W W N <br /> 1p c1 y { � •n �� -� i„ �� ba <br /> rnple ollectwn #of � �$ �� r $ �$ �� x+ 8� � �' Remarks <br /> scnphonw F w rin <br /> r m V} <br /> (0000- �- <br /> _ 07. 9f9 <br /> - o► - w !yr S Lae <br /> 0 7- by 9141 L3 $'r 1 <br /> ( t d <br /> OL 0 3, ro 9f i 3:� S k �C 3' � <br /> PcJ3--03' <br /> �R --ac�_o7 913 ` s p k <br /> No Rehnqulshed by/Affiliation Accepted by/Affiliation Date Ttrne <br /> Cooler Seal <br /> Intal <br /> ® Yes <br /> ❑ No <br /> Turnaround Time <br /> (c.�rcle choice) �--�- <br /> 24 hr <br /> 48 hr <br /> 72 hr O <br /> hr <br /> Shipment Method Additional Comments Q <br /> Shipment Date <br /> Dtstnbubon While Onginsl Yellow Exxon Pink Lab Goldenrod ConSullant Fr-ki Stait <br />