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I'ruc t- Anaiysia Laboratory, Inc 6079 Telephone (510) 783-6951) <br /> 3423 InveStrrrent $outevard 118 • Hayward, Calttorrna 94545 Facsimile (570) 783-1552 <br /> CHAIN OF CUSTODY RECORD <br /> Proj.No. Project Fume <br /> IT2-107 � No. Analyses <br /> Company Name and Address- of <br /> Project Manager. ` <br /> Sample Date lime Cosi- /z. / <br /> ID tainers //lQ / // // // // REMARKS <br /> tI-2l+l tq VW- -k' - ,'- <br /> �-�t-t <br /> Sampled by: (signature) Date/Time Relinc wished by: (signature) pate/Time <br /> GG ` f2-Zl-gS ti �G ` z-21 ��Z <br /> Received y: (signature) Date/Time Relinquis d by. (signature) date Time <br /> I <br /> Received for abo signature) Da .ems/Tl e TURNAROUND TIME <br /> REMARKS Samrl a receipt must-be filled -to by lab <br /> Ice or Ambient• <br /> Preservative <br /> % Heads ace- 070 <br /> Container Type. �_ <br /> Total Numbgr_af Containers- <br /> Other. <br /> Founding Member of the Association of California Testing Laboratories <br /> --P s..i. OT Qr/(,-7/T r1 <br /> rt ;rCT raTr^ <br />