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6-• T ANsoLDRAL <br /> i <br /> ENVIRONMENTAL CHAIN-4F-CUSTODY&°CARD <br /> 6fEOQiEMISTRY,INC. <br /> / ) ' I <br /> CLIENT:' ,t� ��C�`/1CrJ r U—L-2' Q,lf 40X,QS'� /DATE: �VUt/, Ze lrj7f <br /> -- PAGE OF <br /> ADDRESS: P6 6cV 86l sace-lo7C'x 15F ZJCY TEGPROJECT*: 510az <br /> PHONE. ! 44ls-597 FAX J r LOCATION: 713 U/ F?1,wC*i s S' iGlGt�► <br /> CLIENT PROJECT#: S� �' PROJECT MANAGER: � uH•�✓ DATE OF j <br /> COLLECTOR: �� COLLECTION:+t- �5 <br /> E p 3 <br /> Sample <br /> Lcl�tl <br /> E1 <br /> o` m <br /> -0 -6 Num Depth Time Type Container Type FIELD NOTES Z <br /> / 10 9" so,` yl—o1E <br /> � Mp -- <br /> 10 <br /> 1D Mao 5o,4 TU <br /> I5 rwty , I/OA+ ;21; <br /> 0 <br /> z <br /> w 17 Ino tLAY 00A X <br /> l <br /> Al t I+ <br /> REL�{Q ED (Sign ure) RECEIVED BY:(Signature) DATEITIME SAMPLE RECEIPT LABORATORY NOTES: <br /> r YATEITIME <br /> 12W4'4'111:1-5 TOTAL NUMBER OF CONTAINERS FS <br /> i <br /> RELINQ D BY: (Signature) DATE/TIME RECEI v <br /> D BY:(Signature) DATEITIME CHAIN OF CUSTODY SEALS YIN/NA <br /> _ SEALS INTACT? YIN/NA <br /> SAMPLE DISPOSAL INSTRUCTIONS RECEIVED GOOD COND.ICOLD <br /> ❑ TEG DISPOSAL ® $ZOO each ARsturn ❑ Pickup NOTES: <br /> .z a <br /> a <br />