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r �■r r. r• irrr• ■r. irrr• m4r M � <br /> ON-SITE <br /> To: <br /> 7vok TECHNOLOGIES <br /> (Laboratory Name) CHAIN OF CUSTODY RECORD 1715 S.Bascom Avenue C=Vbell.CA 95008 <br /> (408}371-4810 FAX(408)371-2010 <br /> I PROJECT NO. SITE NAME&ADDRESSLir s+b TURN AROUND TIME <br /> r,& 5 f'c�1 ANALYSES REQUESTED FOR ANALYSIS <br /> ❑ 24 HR. to 48 HR. <br /> SAMPLERS:(SIGNATURE) ut m m z ur c D 5 AY ❑ 10 DAY <br /> `�'" m cs •a STANDARD <br /> Fx..- ❑ OTHER <br /> ID NO: DATE TIME a SAMPLING LOCATION o i e3 m z <br /> z ►�- o REMARKS <br /> We- <br /> lot-^J5 C1,C,C. D,, 99 <br /> m <br /> Repan Ann: <br /> (20,1 <br /> Relinquished by: (Signature) Date/time Received by: {Signature) The following MUST Be completed by the laboratory accepting samples for <br /> analysis:Please check Yes or No. <br /> I. Have all samples received for analysis been stored in ice? dYes D No <br /> Reli s ed • (Signature) DateMme R iv by: ignature) 2. Will samples remain refrigerated until analyzed? 17 ye-s ©No f <br /> 3. Did any samples received for analysis have head space? 0 Yes ❑No <br /> y--may }9 <br /> 3, DO 4. Were samples in appropriate containers and properly <br /> packaged? ErVes El No <br /> Relinquis by: (Signature) Dateftime Reeefved by: (Signature) ' S. Chain of custody seal intact? 0'�eS dz(W <br /> Signature Title Date <br />