Laserfiche WebLink
v,/1 ' <br /> Dale�P 3fJ)4 Z We Vier � � —Page of J_ <br /> ERM-WestIj <br /> 1777 Botelho Drive • Suite 260 • Walnut Creek CA • 94596 • {415)946-0455 Chain of Custody Record <br /> Job 9 ,5`j z o f Collection GC GC/MS norg Other Remarks <br /> Job Location 5 F b c k Jzr [A <br /> Sampler(signature) i 7 9 <br /> Pnnled name ���� _ U <br /> yr ry N <br /> Lab Report Recipient `,; , �, U) w m <br /> a. <br /> Telephone Nos�p _ ��- G� �� _ $ o U` <br /> o m o E r w o <br /> Receiving Lab 'exp_ a � m o U ¢ a a o <br /> 41 0 m V <br /> Address <br /> E m 0 0 0 o <br /> b 177 � QrNv Com go <br /> yG m caw 000 m � co co C N � � <br /> N <br /> a vi m a U E <br /> W-water C-cornp W Id a o o o N N a m <br /> Sample IN Time sasoii G= rab Volume 0- U) ►-I m w I to tD to <D tD a � �-� z <br /> q <br /> M W UU r1 S O M 1 <br /> M vjH-3 <br /> CA-z' <br /> s 01:5- <br /> YLA <br /> P__ t�, ____ . x <br /> M uJ-5- 3 �. _ &Y 495 N° _ 01(19 <br /> t__^l _ M 09 7 <br /> Mw <br /> _ <br /> 098,41 <br /> Nl v�"zip .� ,>nt �IcsS t*Z3 y rl1 <br /> Precautions Conc 0 Loo Med 0 Hi Ship Via Total Number of Containers <br /> Sample Relinquished By Date Time Received By Date Time ' Reason for Transfer(List Shipping Bili Number) <br /> to r� �-p ^ {AJC 5 1 6ompany t <br /> t;bmpany _ - eompa"ny <br /> LABORATORY— � Samples Samples Samples E3 *of containers 0 Container tags Cooler seals <br /> Pfe&se Com�lele intact at 4 C Ej not leaking matches Cif-C — ^ match C-of-C r — intact — — — — <br /> �b sample custody — Signature^ — Date — Teme Sample Dispositloll Q Retum to Site Q Discard Q Hold days I <br /> L — — — — — — — ---� — — — ...._ — — -... I — _ — -... -- — _ . _ _ — — . , — — . Z21 89 DJL I <br /> i <br />