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ON-SITE <br /> To ��G� TECHNOLOGIES <br /> (Laboratory Name) CHAIN OF CUSTODY RECORD 1715 S a3aswm Avenue Campbell.CA 95008 <br /> (408)371-4810 FAX(408)371-2410 <br /> PROJECT NO. SITE NAME &ADDRESS Dt,-„,r.rt Lues,6s� TURN AROUND TIME <br /> /5'f 50&-11\ tAa-,,.s% SI remit ANALYSES REQUESTED FOR ANALYSIS <br /> rc� e S n ❑ 24 HR 1348 ISR. <br /> � ��t� � Y � 0 N <br /> SAMPLERS.(SIGNATURE) m w Q 5 AY 11 10 RAY <br /> x D *a STANDARD <br /> a C9 t= ` ❑ OTHER <br /> ID NO. DATE TIME p SAMPLING LOCATION 0 s Ed1: coa. <br /> Zr <br /> z F- to z REMARKS <br /> Ira Et—/►�klf 3 0�N( <br /> Wit—MwL <br /> Repot;Ann- <br /> Relinquished by. (Signature) Datefrime Received by. (Signature) The fallowing MUST 8e completed by the laboratory accepting samples for <br /> analysis.Please chock Yes or No. <br /> I <br /> 1. Have all samples received for analysis been stored in ice? &9s ❑No <br /> Roll ed b (Signature) Datefl-irne R iv by ►gnadure) 2. Will saMPles remain refrigerated unWl analyzed? ❑re—s ❑No <br /> 3Did arty samples received for analysis have bead space? ❑Yes fNo <br /> 3j; 00 4. Were samples in anxDpnate containers and properly <br /> ses ❑No <br /> Relrrrquis by (Signature) r Dateff-ime Received by (Signature) 5. Chain Sr • 1 <br /> custody intact? es N/� ) J <br /> Signature Title Date <br />