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• iA{N OF CUSTODY RECO <br /> 1 / / <br /> !1PLEIRS:(signatule) / <br /> SHIPPING INFORMATION <br /> Phots: <br /> SHIPTO: Shipper <br /> Address <br /> .SR ! jt/k eay Date Shipped <br /> Shipment Service <br /> Airbill No. <br /> ATTENTION: Cooler No. <br /> Phone No. <br /> Relinquished by: (Signature) Received by: rsignarure) Date/Time <br /> Relinquished by: (signature) Received by: (signature) Date/Time <br /> Relinquished y:(signature) Received by: (signatura) Date/Time <br /> tnquishe b�ty,(Sjonaprn Rec ive for laboratory by':(sognature) ate/Time <br /> v� <br /> * alysis laboratory should complete, "sample condition upon eceipt", section below, sign and return top copy to <br /> J. H. KLEINFELOER i ASSOCIATES, 1901 Olympic Blvd., Suite 300, Walnut Creek, California 945% <br /> Sample Site Date Analysis Sample Condition <br /> Number Identification Sampled Requested Upon Receipt <br /> /t y F1f14 $oyo <br /> o S 12A, g/0 kn14 <br /> PPA $0 10It I xtp <br /> r <br /> LAB INSTRUCTIONS: Laboratory reports should reference and be billed by site ID/ and contain the following: <br /> (1) summary of analytical methodology and QA work (blanks, spikes, duplicates) <br /> (2) dates for (a) sampling, (b) lab receipt, (c) extraction, (d•) injection/analysis <br /> (3) detectionlimits for all constituents analyzed for and reporting of all constituents detected which were not <br /> specifically designated <br /> (4) <br /> (5) <br /> White - Sampler Canary - J. H. Kleinfelder i Associates Pink - Lab `ourt*$ AFPY M <br />