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D U D E K Chain - of - Custod`, Form Pan J of t <br /> 605 Third Street 7 Laboratory: QST' Lab Job#: <br /> Encinitas, CA 92024 Lab Contact hi i Method: <br /> Tel:760-942-5147 Project Manager: ,,���� ••r PM,E,m,�aii�l�:,,,,�` <br /> Fax:760.942-5206 6-. N t'R'�'f6J'v "�'°�"'"`Ly oWudek.com <br /> Project Name: Job Number: TY eof Analysis to be Performed TAT S ecial Instructions <br /> Kc (CSF ipgg� �l � - <br /> N o o s <br /> Sampled by: /WA Sampler Signature: ¢ ¢ a, <br /> v <br /> a <br /> d = <br /> Sample Collection Matrix Method Preserved umber of Sam O <br /> le Container = o ¢ N <br /> E a E <br /> z Q <br /> H � p � <br /> en O 0 .., `m .. <br /> Z v E ¢ o ..� U Q C) y m c <br /> v = v <br /> Sam le ID Date Time rpi z x OZ tz Oj O v, ti U F p hI <br /> O <br /> 0912 i� 'X X 3 Z A <br /> Sntw— +0/3i 10z 3 1XI 'X A 3 Z A <br /> . - <br /> 101/31 0$01 X x A 3 <br /> GAB- 1 <br /> 10/3) woo A A 3 R v � <br /> 544w-y 10131 )Z10 A /I 1 3 Z A A <br /> -(B — I r0 31 0?04 x 4 IIIIIIIIIIIIIIIIIIIDIII IIIIIIII IIIIIIIIIII (III <br /> Sm! —; to/g/ 132,3 x x 3 L I IX A <br /> 10l'B 1 H qV )( <br /> ><; 1C 440-223576 Chain of Custody <br /> —1 + <br /> U ( !4ft N j° 3 Z. �( <br /> kr—S t 3 15-5-3A 13 1 Z �a <br /> Total# of containers per ty 2, 4 1 Total#of containers 6� Please return original COC to Dudek <br /> Re ' h�- A lCarnmariv IDate ITIMey Received m n Date Time Sample Receipt <br /> 1711❑ Samples Intact <br /> GJ .� <br /> Cooler Temp: C <br /> t7f145 ❑ Conforms to COC <br /> Ship Date: 01Nov18 1 ��1 of L4 �� c ' C <br /> Track Num: 463602761554 5 3 g"L 2 • ( z_ Rt <br />