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S <br /> k 1- M mor <br /> To ON-SITE <br /> (Laboratory Name) CHAIN OF CUS DY RECORD TECHNOLOGIES, INC. <br /> ff 20949 Cabot Boulevard <br /> Report Attn A, � Gcr�!��`' ® Hayward,California 94545 <br /> (510)7841384 telephone <br /> (510)784-1375 facsimile <br /> Project No Site Name&Address <br /> V1144.,)eeG ANALYSES REQUE=STED TURNAROUND TIME <br /> FOR ANALYSES <br /> SAMPLERS (signature) P O c o ❑ 24 HR <br /> Number- w ❑ 48 HR <br /> ti x ° a X Standard <br /> I D Date Time — Sar 0 <br /> Sampled Sampled 45 f9 Z a w ❑ Other <br /> NO SAMPLING LOCATION i— O , REMARKS <br /> n- , z�1 /0'00 S x <br /> f <br /> 8151- 2 <br /> CI- lv3 I:o� 6��Z S� x <br /> �fr-lnwl Lf-16 �3 x x <br /> af <br /> Relinquished By DatefTime Received By Date/ imeThe following MUST be completed by the laboratory accepting samples for <br /> (signat I r 42 /14q analyses Please check YES or NO <br /> / 1 Have all samples received been stored on ice? l� s [I No <br /> Relinqui ed B DatefTime Receivy Datefl•ime 2 Will samples remain refrigerated until analyzed? p Yes ❑ No <br /> (signature (signature) i 3 Did any samples received for analyses have head space? ❑ Yes t1lo <br /> 4 Were samples in appropriate cont rs and property packaged? fifes 0 No <br /> Relinquished By Date/Time Received By Daleff-ime 5 Chain of Custody seal n cl? Yes ❑ No <br /> (signature) (signature) 11,2 f <br /> 0 <br /> I uomukham ppt Sig re t Title Dale <br />