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nm <br /> 1006M M M� ?w <br /> M M <br /> ,rte_Wealliur _ � Z- <br /> r� <br /> ERM-West Chain of Custody Record <br /> 1771 Bafelho Dave • Suile 260 • Walnut Creek,CA • 94596 • (415)946 0455 — --- <br /> Job>lf 15"?2 06 <br /> Collection GC GC/MS Inarg Other Ren�t�ks <br /> Job Location -S o C LC-m d <br /> sampler(signature) C <br /> N E2 <br /> Printed name C ­D4�v+,r y 1 m <br /> � C <br /> Lab Report Recipient 8 l3 m U a� a b <br /> Telephone No 0 15 a E <br /> Receiving Lab a a m 4s r- u- = Q a. a. { y o o <br /> Z E M 00 n O <br /> Address m ° o o � N N c `^ U <br /> b d � � � _ m L A d m a m E <br /> ur m <br /> Uj Id E N g <br /> W. alor C=camp U Cp to c(0 w w m to 0 Z <br /> Sample ID# Time s.500 G-grab Volume -� <br /> La []tlV ShipVia <br /> Total Number of Containers <br /> PrecautionsPrecautionsConc ❑ ❑Med <br /> Dale Time Reason for Transfer(List Shipping Bill Number) <br /> Sample Relinquished y Dale Time Received By <br /> Company nn _ Vny <br /> F ar- y/�X' 4 <br /> l <br /> zll 77-;i,��4M I R- <br /> ompany amp nyI— A n <br /> ❑ Container tags oo er sea s <br /> LABORATORY— amp as samples ❑ amp ea ❑ I o containers match C-0t G ❑ Intact — _ — — <br /> ❑ intact ❑ at 4"C not leaking matches C-01at — — — — — — <br /> �Rleeae Cam-plsia — — — — — — -- J -- — <br /> [ab sam`pl'e custod n — Signaiure— Date— r Trme I ample Dlsposillon �] Return to 5ne [] Discard ❑ Held —days <br /> 2 21 09 n,t <br />