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CHAIN OF CUSTODY RECORD <br />BC LOG NO. <br />�Cllant name14 �� <br />fPro <br />Job number <br />33U � <br />O Z.. <br />Analyses <br />\(� �Q <br />� �O �O �O <br />�1 <br />required <br />b <br />A <br />c <br />�� <br />b�1°r� Remarks <br />act name <br />9r c Tk,, O d <br />Project manager <br />Sampler(s) <br />Sample <br />number <br />Dale <br />sampledof <br />Time <br />sampled <br />Type <br />Composite <br />or <br />Grab <br />Sample description <br />Number <br />containers <br />FAT- //A <br />5-1'4-B7 <br />D,ri—Hz e7 co K <br />,'T - I g <br />5-14-41 <br />11 5v <br />(�' <br />01 <br />grtz <br />y <br />• <br />� a c�zc rvice �r -�-a �sg f 8 <br />.. <br />r�,aLt Ql�lrlQ �T1'YJ�j�e <br />Signature <br />Company <br />Date <br />Time <br />Relinquished �� , �/ <br />�w <br />`/ <br />moi( <br />p <br />S— �� — <br />Q -c) P <br />Received b <br />Relinquished by <br />Received by <br />Relinquished by <br />Recelved by <br />$RQWN AND CALDWELL Analytical Laboratories <br />3n i <br />�--�/1�2f55.,PrfvJell S�tr et, eryvllle, CA 608 141 428.2300 <br />l�/s Souilti Fair Oaks(Aven e,-Pasaden, 911 3) 681.4655 <br />Note: Samples are discarded 30 days after results are reported <br />unless other arrangements are made. <br />Hazardous samples will be returned to client or dispoted <br />of at client expense, <br />