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' GAIN OF CUSTODY RECORD <br /> SAMPLER,S-ySipna n) <br /> ' , I1 SHIPPING INFORMATION <br /> Phone: <br /> ' SHIPTO: Shipper --r4+, kl,06,Te. / eYM <br /> 06, <br /> Address 2x2G.AAsgik5t. yt4ien <br /> , 75-2),-5 <br /> Date Shipped <br /> Shipment Service <br /> Airbill No. <br /> ' ATTENTION: Cooler No. <br /> Phone No. <br /> ' R quish d y: ' nature LZ �; Received by: (Signature) Date/Time <br /> V <br /> � ��� l 3 <br /> 'Relinquished by: (signature) Received by: (signature) Date/Time <br /> ' Relinquished by: (signature) Received by: rsignature) Date/Time <br /> ' Relinquished by: (signature) MI-Va <br /> rtaAora/tory by':�;gnature) ate/Time <br /> nv �, P <br /> * Analysis laboratory should complete, "sample condition upon receipt", section below, sign and return top copy to <br /> J. H. KLEINFELDER & ASSOCIATES, 1901 Olympic Blvd., Suite 300, Walnut Creek, California 94596 <br /> Sample Site Date Analysis Sample Condition <br /> Number Identification Sampled Requested Upon Receipt <br /> 7 <br /> iliw <br /> I��v�nirde. <br /> 121 - D <br /> LAB INSTRUCTIONS: Laboratory reports should reference and be billed by site IDN and contain the following: <br /> '1) summary of analytical methodology and QA work (blanks, spikes, duplicates) <br /> 2) dates for (a) sampling, (b) lab receipt, (c) extraction, (d) injection/analysis <br /> (3) detection limits for all constituents analyzed for and reporting of all constituents detected which were not <br /> specifically designated rr <br /> White - Sampler Canary - J. H. Kleinfelder 8 Associates Pink - Lab Courtesy Copy <br />