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i i i i i i i i ME i i i i WIVE i i i i <br /> ON—SITE <br /> - <br /> TECH O C)N L MES <br />' <br /> TO ����`"�" CHAIN OF CUSTODY RECORD 1715 5 Baac°m Avenue Campbell.CA 95008 <br /> (Laboratory Name) (408)371-4610 FAX(408)371-2010 <br /> PROJECT NO SITE NAME&ADDRESS ���"' � r.�—� � TURN AROUND TIME <br /> IS-)f e 5 il^��+ ANALYSES REQUESTED FOR ANALYSIS <br /> to 0 24 HR ❑ 48 HR. <br /> '6 y p 5 ICY ❑ 10 DAY <br /> SAMPLERS.(SIGNATURE) -s m '� .s TANDARD <br /> OTHER <br /> '"j car = ` x +S• ❑ <br /> SAMPLING LOCATION ID NO. DATE TIME a GATION a a; o m REMARKS <br /> 'SA-rywl 9 /6 4? to jJlcl��3 1 c�. <br /> `� � � TV 1At— 701- 1, <br /> j C/— AW ONV6, <br /> 0iV1163, <br /> /VN, 10-)5-0 D I VV4 <br /> DIV <br /> Report Attn- <br /> fjZrM <br /> Relinquished by (Signature) Date/Time Received by (Signature) The following MUST Be completed by the laboratory accepting samples for <br /> analysis Please checkYes or No <br /> 1 Have all samples received for analysis been stored in ice? ❑Yes ❑No <br /> Aei, shed ( gnature) Date�me Iv by (Signature) <br /> 2 WHI samples remain retrigerated until analyzed? ❑Yes ©No <br /> 3 Did arr)r samples received for analysis have head space? O Yes D No <br /> 4 Were samples in appropnate containers and properly <br /> I Ian 3-a� packaged? ❑Yes ❑No <br /> Relinqu ed by (Signature) DateRme Received by (Signature) 5 ChMu1 of custody seal Intact? ❑Yes ❑No <br /> Signature Title Date 1 <br />