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FEDERATED I SUIZANCE - <br /> :. P.O. Box 586, Citrus ahts, CA 95611 _ <br /> t t1 1 a R P o 9 ,ti f t o CHAIN OF CUSTODY - - 4 <br /> THE ASSURANCE.OF GUAriEI Novato, CA, I1 Digital Drive, 94949 <br /> //�� <br /> / Phone;/ 415) 883-6100 Fax: (415) 883-2673 U -1 �C <br /> imsuliant's Name: A T ��,n���� 4i 1 nC. Name of Insured: �r/ ��LTe Page of <br />,LIdress: g I Y A41A,— �,.eS� ; /06 /�.� ��� L I Federated Site Location: 1 C-L'N <br />'o'cct Contact: (�r� Lam, Phone #: I G - s'U ��Fax # d Federated Contact: <br /> uii leel b ( tint): d Lrvic U 2 Sampler's Signature: !� P Phone #: Fax #: <br /> tipment Method: 1 5(� P�u� Consultant Project #: QIP b Z �v Federated Claire#: <br /> 1T: ❑ 24 hr ❑ 48 hr ❑ 72 hr Standard(10 day) Sample Condition as Received <br /> AN REQUIRED Ternperature°C: <br /> Cooler#: <br /> N Inbound Sea] Yes No <br /> $ Outbound Seal Yes No <br /> e/I V'1 H <br /> ample Description Collection Matrix Prsv #of PACE 012 q 0 <br /> Date/Time soil/Water Cont Sample# COMMENTS <br /> HW hW <br /> w . 6 a s <br /> I <br /> Relinquished by/Affiliation Date Time Acccpicd by/Affiliation D leFill <br /> Additional Commcots: <br /> 1 L a SLNL <br /> 1 <br />