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• CHAIN OF CUSTODY RECORD Pma <br /> SAMPLERS:(Si arum <br /> leg��,[/V y i;. <br /> M SHIPPING INFORMATION <br /> Phone'—. <br /> SHIPTO: Shipper Jr}i!e Fif¢I't7z ' f aa"Cr <br /> Address <br /> `1167 Nr C-)II- S!!/TT/ ?iDateShipped <br /> SLc �i1• 437 ShipmentService <br /> Airbill No. <br /> ATTENTION: 56'X Cooler No. <br /> Phone No. �-75-2("75 <br /> Rel' quished b • (Signarura) Received by: (S,9narure) Date/Time <br /> Ren uished by: (S nature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature/ Received by: (Signature/ Date/Time <br /> Relinquished by: (Signature) Recei for labor ry by':(S,9nature) D to/Time <br /> ( j114- <br /> 'Analysis <br /> J <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 /> 2G W-2ao(- 1 /2- l/-85 Ch,��S Yka'c� r T.stS <br /> � � �. _f/� W LAI (/i 16 g T•e <br /> �3Y 4 S-2 4.5 e. Z <br /> bLlnklc 6VCA 1- Sal ,f- i� cto de4 ;H coati a <br /> �F 14unf <br /> i�vt abv�i'Le s' <br /> rYlZl'd Scat 41 — 41r�i G 4fryy / !ad m)ur. Cti r u rrt iy* beds_ <br /> 1JC001 31nc, S)Ivev 01 T)fanlvw <br /> 1`144 eY Tori$ — :56diui4 I, Cticlvnt� rtl4g esicJK4 =rte , IP6+,-gs}}l��VM <br /> �c(/1+b�-rlG�t � C�irl7on Y�DH�rT <br /> LAB INSTRUCTIONS: Laboratory reports should refereree a d be b led SyOsite end Lain the following: <br /> (1) suamary of analytical methodology and QA work (blanks, spikes, duplicates) <br /> (2) dotes for (a) sampling, (b) lab receipt, (c) extraction, (d) in,)ection/analysis <br /> (3) detectionlimits for all constituents analyzed for and reporting of all constituents detected which were not <br /> specifically designated <br /> (5) <br /> e fe-usm GF} <br /> f�loJ d <br /> White - Sampler Canary - J. N. Kleinfelder i Associates ----rink - Lab Courtesy Copy <br />