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CHAIN OF CUSTODY RECORD <br /> Client name <br /> Send Lab. Results To; LOGE address below <br /> .�---� LSCE r0)eCl NO. - <br /> / V CI�/U/�LI$� Analyses`—O � G. Afyee� required <br /> Project name <br /> Project manager Sampler{s} \ <br /> Type <br /> Sample Time Co,npaeltr <br /> Data Sample description Number <br /> number sampled Grab sampled of tb ! <br /> Matrix (Location Details) Remarks <br /> !UB <br /> �3d �c °r3 5-2-y6 S.i At✓Y #! <br /> �0 3 P S 9660 U s ,t&-kV 1 _ <br /> *Sample Container Desorlptfon <br /> 1. Polyethylene, nopreservatives 4. Polyethylene — sterile <br /> 2. Polyethylene, preacidltied 5. 40 ml Glass Vial. duplicate . <br /> 3.- Glass, screw cap 8. <br /> Signa urs <br /> r <br /> canp+nr Dale lin <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Received by <br /> Relinquished by <br /> Luhdorti and Scalmanlni. Consulting Engineers <br /> - 500 f=irst Street, Woodland. Ca. 96856 <br /> .�: V Phone: (916) 881-0109 Contact Person. ESQ �CHA <br />