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' Trace Analysts Laboratory, Inc Telephone (510) 783-6960 <br /> 3423 Investment Boulevard #8 • Hayward California 94545 Facsimile (510) 783-1512 <br /> CHAIN OF CUSTODY RECORD <br /> Proj.No. Project NameUl <br /> r l'c t C No. <br /> Analyses/ V- W <br /> Company Name and Address <br /> Gro�� <br /> kV-2— C Ptve -Z of <br /> A <br /> —Project Manager. <br /> Sample Date Time Site Location Con- <br /> ID <br /> tainers REMARKS <br /> AA w- s,00 <br /> Mtw- 'T,W <br /> I <br /> 4cei <br /> by: (sinature) Date/Time Relinquished by: (signature) Date/Time <br /> Q- <br /> I b* -.:L(sgilgLure) Date/T me Relinquished by: (signature) Date/Time <br /> Received for Laboratory by: (signature) DAte,/Time TURNAROUND TIME <br /> D;30 <br /> REMARKS _Sample recent must be filled in by lab <br /> c or Ambient <br /> Preservative- <br /> % Heads ace 00 --C-- <br /> Container -Type: — go -.,/ /c,17_ <br /> Total <br /> - <br /> Total Number of Containers. �t <br /> t 1 Other: <br /> � I <br /> Founding Member of the Association of Catrfornia Testing Laboratories <br />