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Calscience EnviCHAIN OF CUSTODY RECORD <br /> I. Oental Laboratories, Inc. • <br /> �f 7440 Lx�iwnWay 5063 commarcl circle.SuxeN Data /p'/U'U} <br /> L <br /> Ge"i Grove,CA 92841-1427 Concor4 CA 9452685)) /L- <br /> (714)8950494 (925)NO W22 page S 01 6 <br /> UBOMTORYCLENT CLIENT PROJECT NAME(NUMBER: P.O.NO.: <br /> R ON L <br /> AOOflE33: f 4 <br /> 00 y P W d/yi P0.0J Ci CONTACT: IAB USE ONLY <br /> CRY STATE IIP ,$.L.MF�rL �,-/A <br /> �NN F 18 SAI IERIS)ffINT1 COELT LOG CODE F CER RECEIPT <br /> TEL ElMIL: ti � ❑❑❑❑ <br /> '4444 C' ,co..., --1;"F�La- TM a TEMv- °C <br /> ruxxee U TIME: REQUESTED ANALYSES <br /> ❑SAME OAY ❑24 HR ❑40 HR ❑72 HR ❑SCATS ❑10 DAYS <br /> SPECIAL REOWREMENTS(ADDITIONAL COSTS Na rAPPLY) <br /> P.V <br /> ❑NCR REPORTING FORMS ❑COELT EDF ❑ $ — M <br /> SPECML INSTRUCTWNS: <br /> U <br /> O oDo Ed <br /> U Ed $ d <br /> CO <br /> W FIELD POPE NAME SAMPLING x0IS <br /> tireSAMPLER) la <br /> FOR COELT EDF)( TE TIME 6 It F ~ <br /> `n/ <br /> , m4iF <br /> Y <br /> o:RS <br /> STI--I - 5 0 /P:}p <br /> ' ST - III -5-,S //:OS <br /> 51K- Is' -5- a /o:y0 X X <br /> 4� sTk- I� - /D:Sp <br /> Relinquished!by:(Slgnalure) 4RB- .d <br /> by alma) Dale: Tvne: m <br /> 7�, IYzp <br /> Rerngvisne00y:(SigmRUNU y:( UraluNANil0110a Oale: Txn <br /> c 5= „ me: <br /> ftelinquisM1¢E By:(Si9nalum) y:(SgnalumlAllliNion) Oale: Time: <br /> b <br /> O <br /> Penn...DISTRIBUTPar:WTpe I a 612112 of Grew and prof III CUm p5101N7 Revspn <br /> Pkaze mle Dal W9es 1 and]n1201wr TICa are pmle00n Na reverse ai0e OI IM1e Blaen en0 YeYO.v COpies Itlgedrv¢IL <br /> Calscience Environmental Laboratories, Inc. CHAIN OF CUSTODY RECORD <br /> E ❑ SOCal Laeoral0ly 'E] NmCaI Be,..Censer Oale /O'/O'O�- <br /> ' fir NIG Lincoln Way SOBS COmmm ill Circle,SuxeN <br /> LGerean Grave.CA 9 2 811-1 4 2 7 COncOM,CA 94520-8577 <br /> (714)395-519,1 (9251889-9022 Page ( 0� . I <br /> U30PATORV CLIENT CLIENT PROJECT NMIE I NUMBER'. PO.NO: <br /> ,' 'F'� 0 <br /> ADDRESS <br /> PROIECL CONTACT. <br /> '14.0 <br /> 5 v dna PKw /zz ue LDE ONLY <br /> I� <br /> CITY STATE ZIP r•fF <br /> �VIN� GA� ej i6/I✓i SAMPLERISI&!(' NT) MILT LOG CODE .COOLER RECEIPT <br /> TEL: - 'yY EMIL Ma_art .Cee.+ "`f'+z /'/ud4 �l <br /> �A'sn-SII ❑I❑❑ TEMP= °C <br /> iU HAROUND TIME: /��.y.� <br /> El GAME DAY L 2 NR C]J8 NR ❑72HR 5DA-Y5oDsn4s REQUESTED ANALYSES <br /> ESp00ITIOHgL LO5T3MPY <br /> Q0LRINGER <br /> FREPORTING <br /> FORMS aRrc❑n COELT <br /> µ}E-D�D cri <br /> _ <br /> SPECM INSTRUCTIONS s — <br /> do <br /> LERSE FILTER Nets U1de.S�IIIe- � r g � <� m � n a . <br /> LE�+rE i}�, � srK-�8wn&� sTK—�RMla43 � R.ti <br /> cL <br /> � ° <br /> wSAMPLE IO FIELD POINT NAME SAMPLING aF p=. $ S W U V <br /> ONLY (FOR COELT EOE( ppiE PAPE �1PiF COxi. F d O) ? (pJ d <br /> V > <br /> ' f" STK— 2um1A I 1-y-0? /.S:oD soil I-irc <br /> q 5T K- 0" J-6 <br /> JCO 5T9- Or,a,n o-/a- l2'.lD AI 3 �( <br /> 44 <br /> N <br /> RelinquuNetl by(Sgnalure) Receive :(5-g IumlAMlialio Dale: Time on <br /> m <br /> p /a e 19zo B <br /> Re6n0uisNed bYaSgnelure) ReuAed .(.9cademA lion) Dale: Time: <br /> aL, UD c;,-,,� <br /> Relinquished by:(Signature) Reew ey:(SgnaurelAMl011en) limlie, Lf <br /> DISTRIBUTION:WNxe MN foul mBeL Green and Y.M.IO CI PR0 <br /> Please more Net pye°1 and 2012 of our T/Cs ere worse on Um reverse aNe 01 Ne preen aM YelbwmPks rexpecliaeN. OSNia7 Reruion <br />