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CAAUNl.Ul1llt' �>f° <br /> i 6 tivaal�eakr3 i7r � <br /> tl C ly CA 94063 P O Boz 2160,liousl U.O.A.77002-7426 <br /> (415)364 9600 • FAX(415)364 9233 CHAIN OF CUSTODY <br /> Consulltarll's Name ;� Page of <br /> 1_ ��� rte - - ��i2 f _ <br /> Address ;_fV _ & Yec 'Y4 L V - - Site location c V <br /> Project # Consultant Project # �� �',� Consultant Work Release #.n <br /> Project Contact ����1 / �� Phone #. �y' ��ei �1'i� — laboratory Work Release #. .- <br /> _ jF c <br /> EXXON Contact ;4-1 �� / •� Phone # EXXON HAS T <br /> #, <br /> Sampled by (print). J C��r, �' Sampter's Signature i <br /> Shipment Method Z'—-4e- Air Rill # fl <br /> TAT IJ 24 hr 1-1413 hr U 72 itir U 96 hr Standard (10 day) ANALYSIS REQUIRED <br /> Sample Collection Collection Matrix # of Segilola's TPH/Gas TPW TRPIi Temperarura <br /> Dale Time SodlVJaler/AEr Prsv BTEX/ Diesel S M <br /> Description Cont Sample # 80151 EPA 5520 Inboundssal Yes No <br /> 13020 8015 Oulbaund Seal Yes No <br /> Cr <br /> Da NL <br /> 40-1 <br /> 'ylob <br /> E <br /> RELINquISHED BY/AFFILIATION Date Time CCHTED Date TIM Additional Comments <br /> Zvi � �f �� l�{DU -S�G�lQ14 too <br /> I � c <br /> y <br />