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0 Soo-?w&7 U I W, ) 0 <br /> ERM-West, Inc.n CHAIN OF CUSTODY RECOR 1 3 9 3 <br /> 455 Capitol Mail, Suite 800 • Sacramento, CA • 95814 • (916) 444-9378 • Fax (916) 444-5313 Page c - of <br /> PROJECT# PROJECT NAME <br /> L-9/iLs MATRIX REQUESTED PARAMETERS <br /> SAMPLER (PRINT NAME) (SIG ATURE) <br /> RECEIVING LABORATORY <br /> � - C4 V <br /> SAMPLE I D DATE TIME m SAMPLING m> wz SAMPLING <br /> U METHOD ¢? U VOLUME <br /> a <br /> CA gm x y <br /> 1X50 ) iao <br /> REYNQUISHBY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME FIELD REMARKS <br /> t- NAL _�" 6a ja, rcr 1003 01 is t t' i �,r �E t ��Lt,t I ,►� <br /> ELINOUISHED BY(SIGNATURE) DATE TIME RECEIVED B DATE TIME <br /> /RELINOUISHED BY(SIGNA RE) DATE TIME AM4CEIVIED BY DATE TIME <br /> vN11fV1 I71`0 <br /> REMARKS ON SAMPLE RECEIPT ERM REMARKS SEND REPORT TO <br /> ❑ BOTTLE INTACT ❑ CUSTODY SEALS ❑ CHILLED <br /> ❑ ���� <br /> PRESERVED ❑ SEALS INTACT ❑ SEE REMARKS <br />