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U D E K Chain - of - Custod Form Pae 1 of <br /> 605 Third Street Y Laborator : ear" Lab Job#: <br /> Encinitas, CA 92424 Lab Contact: r Shioving Method: CL/tz/. }GrrL <br /> Tel:760-942-5147 Project Manager: PM Email: <br /> Fax:760^942-5206 , t At� <br /> Project Name: Job Number. T e of Anal sis to be Performed TAT Special Instructions <br /> Sampled by: Sampler Signature: <br /> 00 <br /> � � c <br /> Satn le Collection Matrix Method Preserved 4umber of Sam le Container o Q N <br /> a <br /> 7-. t. <br /> Sample ID Date Time c� z Q ti ' � U p <br /> W I Z <br /> A 3 Z <br /> b-' 40/31 0501 X x A 3 Ze <br /> tB- 1 10/3) P100 X 3 1Q <br /> -� t013i Il Zn x X 3 1 � <br /> 44 <br /> w-� 1013( )ZIO -K X 3 Z _ <br /> -rB - I t 0 3f o?00 X <br /> SM IV-Z to/g/ 1123 W A x 3 Z X <br /> �� 14 440-223576 Chain of Custod <br /> 31 <br /> k -S� t 3 1 Z <br /> Total# of containers per ty Z Total#of containers 6 Please return original COC to Dudek <br /> Re'-4.16-1 hw- Company Date Time <br /> Received m n 'Date Tim Sample Receipt <br /> J2 ❑ Samples Intact <br /> 1 <br /> �_" ,� ❑ Cooler Temp: a C <br /> oq4 ❑ Conforms to COC <br /> Ship ©ate: 01 Nau18 i a—tC1 4•o L4, U'L ,— <br /> Track Num: 463fi027fi1554 � 3 °L <br /> I <br />