Laserfiche WebLink
)OC96 FEDERATED INSURANCE <br /> P.O. Box 586, Citrus Heights, CA 95611 <br /> tNcopPoaarto <br /> THE ASSURANCE.Of 0UAl11T KX CHAIN OF CUSTODY <br /> Novato, CA, I I Digital Drive, 94949 <br /> Plione: (415) 883-6100 Fax: (415) 883-2673 <br /> ansultant's Name: �{ g GF1�«o Natne of Insured: r <br /> Parc 1 0l <br /> 3dress: ^) h <br /> o' <br /> L SV h �cyy �u _ S: i r- )(�yKG e ,� A `36..;lY Federated Site Locatio- <br /> n: <br /> r.1 iCA <br /> ect Contact: f`t� [� Phone#0/0 �z-2110 Fax#0/0 � ��3G Federated Contact: 661L <br /> marled by(print): S t{.)e— Sampler's Signature: Phone Fax ?= <br /> ipment Method: Consultant Project b: q(, -C)r1C! Federated Claim #: <br />,T: ❑ 24 hr ❑ 48 hr ❑ 72 hr Standard(10 day) Sample Condition as Received <br /> ANALYSIS RE UIRf?!J Temperature°C: <br /> x Cooler#: <br /> N Inbound Seal Yes No <br /> 0 <br /> Outbound Seal Yes No <br /> imple Description Collection Matrix Prsv N of PACE <br /> Date/rime ScIMMer Cont Sample p x d 1 <br /> �w �w COMMENTS <br /> 1-22J3 wG�, tL <br /> IdIci <br /> i-Relinquished by/Affiliation Date Time Accepted by/Affiliation Date Time Additional Comments: <br /> •'� rs / G� v <br />