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ERM-West, Inc. CHAIN OF CUSTODY RECORD Cz <br /> � tg6t <br /> 1777 Botefho Drive, Suite 260 • Walnut Creek, CA • 94596 • (510) 946.0455 • FAX (510) 946-9968 , <br /> PROJECT <br /> 9w, <br /> E, ECT# PROJEt ( � age of a <br /> CT NAME <br /> ZAl,f{a l(U 5 — 5 k {,�,,., MATRIX RE ESTED PARAMETERS <br /> SAMPLER (PRINT NAME) (SIGNATURE) • '�-� L <br /> RECEIVING LABORATORY � � <br /> �i1 C � C 4 rj C . • � '�.. ."� <br /> I Iry ZV z <br /> a <br /> SAMPLE I D a. <br /> DATE TIME m SAMPLING w? <br /> yti wz SAMPLING <br /> c9 <br /> METHOD a> v> VOLUME <br /> —� �� 3X Yoe+, 3 <br /> L <br /> 13 �C L <br /> � M W s <br /> v� !mss <br /> -511 ( off <br /> X a �c x a �C <br /> R INOUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME <br /> ]' I=1ELD REMARKS <br /> ltgo <br /> REL! UIS (SIGNATURE) DATE TIME ECEIVED BY DATE TIME <br /> te cr <br /> RELIN ISH E (SIGNATURE) DATE TIME y��� !�I <br /> CEIVED BY BATE TIME <br /> REMARKS ON SAMPLE RECEIPT ERM REMARKS <br /> ❑ BO INTACT ❑ CUSTODY SEALS ❑ CHILLED <br /> 13SENrD REPORT TO <br /> PR VED ❑ SEALS INTACT ❑ RIFF REMARKS a �,i 1 I `) u t 1 <br /> � � I♦ � � � � � `a■• 4fir �r -mss -�r� ..� [ l4 <br />