Laserfiche WebLink
Field Sample Chain of Cu-',)dy Record Kennedy/Jenks/Chilton <br /> ',,,, ')1C Laboratory Division <br /> YL <br /> = <br /> Source of Sample (s) <br /> 5 f c, Ic o, Lt,:f'E j WM Job No. DD 8 0 O <br /> 5J-o-0( �iS+ . 9 Sf� � �� S Collector '7U(,• r`uSst�� <br /> Address <br /> 5 �f Affiliation F1 1►,;(fit ar-� /-e,, "Pr <br /> �. Address 37 S o AP. g1"'A <br /> Phone 5vIe A , SGc.u,,•L. �v , CA 9�gz I <br /> �. <br /> Report to <br /> �� Phone q16 " 49. - 7 2 Z Z <br /> .. Sample Information (1) <br /> Lab No. Field No. Date Time Type Depth Remarks (Suspected Contaminants, Con- <br /> (Lab Use Only) (2) r tainers, Preservatives, Field Conditions,, etc.) <br /> C1 <br /> 0cr11 <br /> ( D� 0511 IZ/zjr� O 1105- 50"11(vi � Qf�'Sat♦ F�e� � jrr� sS '�'s~tbCY <br /> V <br /> 4,0 r 'Al �- �r-4r-�"��� l✓{ C- _ <br /> 4.0 <br /> '} U <br /> i., t�N .Its._ r�� Ic=-�:-e- <br /> Chain of Posseksian �. <br /> Relinquished by Date Time ' Received by(3) Date Time <br /> 'r (Signature and affi4iation) (Signature and affiliation) , <br /> �i}oot' 1z/rI/go 11030 t �� t <br /> tGrnDr,Tf� t _ j<IS C �.R�1 Ar• S� r <br /> 2. <br /> Logged in at K/JIC by <br /> (1)A separate laboratory Analysis Request Form is to be filled out by the collector and given to the laboratory when samples are delivered. <br /> (2)e.g.water,sludge,soil,etc. <br /> (3)if any samples are not intact at time of transfer,please describe on the back of this form. <br /> Each batch of 10 or fewer samples of each matrix type(soil,water,etc)must include enough of one sample for triplicate analysis. <br /> WARNING These samples contain unknown chemicals which,upon analysis,may be determined to be"known to the State to cause cancer or reproductive toxicity." <br /> ,r-jF,.��rn�t, a cz_�...��,:-„7 L�,arP.�.-.-r��y;r•�Cn':�.-�-„�.- q71 or 1oRF T:^1osifin-,651 <br /> -: r <br />