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M >• � r r rr rr Ir it r lr r ru r r � � r <br /> M TEG NorWn California Inc. Chain of CusWy Record <br /> 11350 Monier Park Place i Ph: 916.853.8010 Page: of <br /> Rancho Cordova, CA 95742 ' Fax: 916.853.8020 <br /> Client: �c� 2` Project Manager: iJh� 6104 <br /> ----� <br /> Address: J(.-QS ��--ke Sw:: 1 TEG Project#: 20521 Client Project#: <br /> PLQ,-c" C ewe w-ax C-f4 I'1'3d Location: � <br /> Phone: Fax: qD °l$1--t�S'4, Collector: Date of Collection: S`Iz =),z <br /> t1 <br /> 05 � <br /> Sample Container <br /> Sample Desi nation Date Time Matrix Tvne AQP AQP AQP AQP AQP lbhp� �Q� �QZ' �Q� ��Q Field Notes <br /> I IFT E5 X <br /> 2 Z F+ C 5 'f <br /> F-1 5 +� <br /> SFT lioo u <br /> 5 6F—( 1,540 <br /> 5.5 FT R t3545 <br /> 16 FT 6 135-5- x <br /> Relin wished by: Date 1 Time Received by Date J Time Sample Receipt: Remarks: <br /> ZJ 07. 1ST <br /> R inquished by: ; a e 1 Ti Received by Date 1 Time Good Condition? <br /> Cold? <br /> Relinquished by: / i Date 1 Time Received by Date 1 Time Seals Intact? <br /> Total Number of Containers <br /> Distribution: White-Lab.Yellow-File,Pink;odglnawr Sample disposal instructions: _TEG disposal @$4.00 ea. _,Return to client _Pickup <br /> ill '` <br />