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�I= _ <br /> ON—SITE <br /> ~f 7t✓�k TECHNOLOGIES <br /> (Laboratory Namo) CHAIN OF CUSTODY RECORD "S5{ o0`o f FAX(408) A9 °°a�37 <br /> 10 <br /> PROJECT NO SITE NAME 8 ADDRESS rtet Lu 1,4 TURN AROUND TIME <br /> ISt 0&i51'�r ANALYSES REQUESTED FOR ANALYSIS <br /> ❑ 24 HR O 48 HR <br /> SAMPLERS (SIGNATURE) � �� m m z to � ❑ 5 AY ❑ 10 DAY <br /> STANDARD <br /> cr <br /> ❑ OTHER <br /> ID NO DATE TIME 0 SAMPLING LOCATUN 0 <br /> REMARKS <br /> E t (g o +' 3 <br /> sFo -3 <br /> J",'-39 5 <br /> ,7tr <br /> d'A cICYYI <br /> Report Attn- <br /> fw, Mic,"Or"t <br /> Rohnquished by (Signature) Daterrime _ Received by (Signature) The following MUST Be oompleted by the laboratory aocaptrng samples for <br /> analysts Please check Yes or No <br /> 1 Have all samples received for analysis been slored in ice? c(Yes ❑No <br /> Roll u s od by (,Signature) Date�me R etv b r nature 2 Will samples remain ret <br /> - y g ) ngerated until analyzed? ❑yes ❑No <br /> J 3 Did arrlr samples received for analysts have head space? ❑Yes ❑No <br /> 3, � � 4 Were samples to appropriate containers and pr�operfy <br /> 1 packaged? l3Yes ❑No <br /> Relinquish by (Signature) Dale/Time Received by (Signature) 5 Chain of custody intact? <br /> es <br /> Signature Title Date <br />