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CHAIN OF CUSTODY RECORD � <br /> ERM-West, Inc. �� __- EMF 2 3 4 6 x <br /> 17'.'7 3ote!!ic O :ve, 5u;re 260* Walnut Creek. GA. • 3ea96 • i510; gab-0455 • FAX ;570) 946-9968 'age <br /> PRO„ECT# ' PROJECT NAME � <br /> — MATRIX REQUESTED PARAMETERS M <br /> I SAMPLER:(PRINT NAME) (gl(', E) i <br /> RECEIVIP�G'� DRA ORY ti� �K Z <br /> g SAMPLING W y z SAMPLING �C <br /> SAMPLE I.D. DATE TEME p METHOD c} L)> VOLUME ' . <br /> a <br /> Tl <br /> -4 3105 is-45 X nrw5s e <br /> Ci 2 C� X( 5(. <br /> .klh -'I' fi 11717 X I i m t. 1 tE 1ewro o <br /> CD <br /> X ao <br /> 0 <br /> REL Ui E BY( TU )/17 DATE TIME RECEIVED BY DATE TIME FIELD REMARKS <br /> N <br /> N <br /> a5 / ,a►� S �� q. cab <br /> I-RUNQUISHED.B ( NA ) DATEF TIME RECEIVED BY DATE TIME <br /> IL 2la zx e f p"PI <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE IME <br /> REMARKS ON SAMPLE RECEIPT ERM REMARKS SEND REPORT TO: CIS -''J <br /> ❑BOTTLE INTACT ❑ CUSTODY SEALS ❑ CHILLED n �pF:A It r� � �CNtr�a 24A Ylk$- 3N33 N <br /> ❑ PRESERVED 0 SEALS INTACT 13 SEE REMARKS 2 r ' ` vf` �V ��l�` ftl <br /> WHITE-LABORATORY COPY CANARY•FIELD COPY PINK-DATA9Asr-MANAGER c-,n1 n-PRC),IFr.T Fu F <br />