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Tma"EMIO CHAIN OF CUSTODY RECORD Paofd. <br /> Environmental and Geotechnical Consultant Page <br /> 555 Montgomery Street,Suite 1300,San Francisco,CA 94111 Ph 415-955-90401 Fax 415.955-9041 <br /> 2 Theatre Square,Suite 21&rinda CA 94 h 925.253.49801 Fax 925-2534985 <br /> 01 14th Street,3rd Floor kland,CA 946 Ph 510-8744500/Fax 510-8744507 <br /> Site Name <br /> Job Number - <br /> Anal uestedg" <br /> Project ManagerlCantact <br /> Samplers t O <br /> Recorder{Signature Req d} No.Containers 3 U <br /> Matrix &Preservative 1 d <br /> Field Sample Y ,' � n` =� ��r �:,_, b @ a, J � 0 � <br /> Identification No Date Time lab Sample No O N Q 2 a 1 <br /> �-E -- 6-l�-0 <br /> _ � Remarks <br /> ► r a kk A <br /> 4 <br /> �t t <br /> a rt POA 111 <br /> ------------------ <br /> `eyv1 <br /> ------------------ <br /> Enqu h y ignatur Datt> <br /> f �I�l J rmp� <br /> LV. Re ew by (Signature) Date Time <br /> q h d by (Signature) Data ' T T C j Z <br /> Time Received by (Signature) Date Time <br /> Relinquished by (Signature} Date Time Received by Lab (Signature) Date <br /> Time <br /> EtoLaboratory(Name) Method of Shipment Lab couner LJFed Ex �Airbome UPSmments/Notes Hand Carried Private Courser(Co Name) <br /> White Copy-Original Yellow Copy-Laboratory Pink Copy-Field COC Number Q 0 3 3 1 J <br /> � �0= M = M = = .. AMM = = = M � <br />