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r * iAIN OF CUSTODY RECOW Cl ob4, a'7073 <br /> 3 PLEBS:(Stgnatun) <br /> SHIPPING INFORMATION g <br /> Phone: <br /> SHIPTO: _ Shipper <br /> /1 AJA(,14 t'( 1--A b S �c Address <br /> 14//S Sftt 61/VfLJ40 " Date Shipped <br /> Shipment Service <br /> Airbill No. <br /> ATTENTION: Cooler No. <br /> Phone No. <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished y: (Signature) Received by: (Signature) Date/Time <br /> RgPinquished bAign re Rec ive for laboratory by':(signature) I ,Date/Ti <br /> me* alysis laboratory should complete, "sample condition upon ieceipto, 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 /> F-iPA Soso <br /> 84 IS Op <br /> �'c G Soso red A214 #A <br /> LAB INSTRUCTIONS: Laboratory reports should reference and be billed by site IDI 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) detectionlimits for all constituents analyzed for and reporting of all constituents detected which were not <br /> specifically designated <br /> (4) <br /> (5) <br /> Whitt - Sampler Canary - J. H. Kleinfelder i Associates Pink - Lab Courtesy Copy <br /> IHK&A Form M{,C <br />