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LAB: <br /> . 111111101111111 EQUIVAServiSs LLC Chain Of Custody Record 1q10AP <br /> Lab Identification(if necessary): Equiva Project Manager to be invoiced: INCIDENTNUMMIR(S&F.:ONLY) <br /> Address. Karen Petryna 91 71 01 91 31 41 1 1 9 DATE. <br /> City,State,Zip: <br /> TECWdLSERVICES;,. SAP or:CRMT N4JM13ER(TSIORMT) <br /> ME PAGE: Of <br /> CONSULTANT COMPANY: SITE ADDRESS(Street cad Cltyl: <br /> Blaine Tech Services <br /> ADDRESS. 1267 Country Club,Stockton <br /> 11680 Rogers Avenue PROJECT CONTACT(R.poill to); CONMATANT PROJECT NO.: <br /> CJY: Nick Sudano IBTS# C_Z <br /> SAMPLER NAMqS�(P": <br /> San Jose,CA 95112 LAS USE ONLY <br /> TELEPHONE: FAX <br /> 408573-0656 408-573.7771 nsudanoQbIalmotach.com <br /> TURNAROUND TIME(BUSINESS DAYS): <br /> 0 10 DAYS [3 S DAYS [3 72 HOURS [3 48 HOURS E3 24 HOURS 0 LESS THAN 24 HOURS REQUESTED ANALYSIS <br /> 0 LA-RwQcB REPORT FORMAT 0 LIST AGENCY: <br /> E <br /> GOIMS MME CONFIRMATION:HIGHEST X HIGHEST per BORINGALL E <br /> z FIELD NOTES: <br /> SPECIAL INSTRUCTIONS OR NOTES: TEMPERATURE ON RECEIPT C* In1 0 w ed, IiI ContalnettPreservativo <br /> 4cc4- 14TSE 4t4cAon <br /> 0- or PID Readings <br /> or Laboratory Notes <br /> ID <br /> LAB SAMPLING i4o,OF ewo M, In LU <br /> VS0 DATE TIME I-Field Sample Identification MATFLEX comir, A. <br /> ONLY - <br /> MAO —32- <br /> /310 Ix —N "X —03 <br /> x —0q <br /> JL %r-, <br /> CNI <br /> O <br /> � X I <br /> R (Signature) Received by(Sgnature) Vale- Time: eo <br /> .0WncfasFeffDy.(agnattiref Recelwd by:(Signati.90 0010: Time; <br /> - ----------- <br /> R,,lnqushed ty:(Silinatural Received by.(Signature) 00110: Time: 43 <br /> ZA <br /> rxIFTR V ITION White with final report,Green IG File.Yellow and Pink to Client 1011640 Revision <br />