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CHAIN OF CUSTODY RECORD Ph61 �. t4; <br /> t P TrvY <br /> SHIPPING INFORMAT10 <br /> Phone: 7t'kl�t✓ <br /> SHIPTO: ' n Shipper `�' �' �•rl ft. be <br /> rttP1� l. Address <br /> �ri 5uit7i 0 Date Shipped I. <br /> ILO 371/ Shipment Service <br /> n uid J•. Airbill No. <br /> /Q <br /> ATTENTION: Dl Nl•-I Sept Cooler No. <br /> Phone No. 77 S —2 r'1 6 <br /> Re ( q iµshed b�(si uraf Received by: (Signature) Date/Time <br /> R li uished by: (signatur Received by: (Signature) Date/Time <br /> Relinquished y: (signature) Received by: (signature) Date/Time <br /> Relinquished by: (signature) Rec e f r lab ratory by':(S,gnature) D to/Time <br /> 'Analysis laboratory should complete, "sample condition upon receipt", section below, sign and return top copy to <br /> J. H. KLEINFELDER & ASSOCIATES, 1975 ••E" Street, Fresno, California 93706. <br /> Sample Site Date Analysis Sample Condition <br /> Number Identification Sampled Requested Upon Receipt <br /> 3� �d w-�a- r ri-il-sS (o2y <br /> 326:0 <br /> •I bLD <br /> 32 � •� �'LS tta�p <br /> Tial &J�1-Iles — q �6 v.k.:cct 3 �t dv�i����s <br /> ii-y� I ab use as )ieede <br /> I d1a14 L C JO A, <br /> t — nu,xY�rj 32 -Dy 3Z$S 32bCo ka,.< duP�la <br /> LAB INSTRUCTIONS: laboratory reports should reference and be billed by site ID/ and contain the following: <br /> (1) &Lmeary ofanalytical methodology and QA work (blanks, spikes, duplicates) <br /> (2) dates for (a1 sampling, (b) lab receipt, (c) extraction, (d) infection/analysis <br /> (3) detectionlimits for all constituents analyzed for and reporting of all constituents detected which were.not <br /> specca des <br /> (4) ;;a2 W4 " OK10 <br /> SZZ <br /> (5) 325 3� 3Y f.8 fsut'TS FatMA <br /> + �� Si S •F 3z.So 3' 52 , <br /> osu r , , <br />