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_ MR6?0TrCN-jT1r. WLU INMAE BM <br /> FOLSOM, CA 95630-471 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY (916) 985-1000 FAX (916) 985-1020 <br /> N9 024679 <br /> CHAIN-OT-CUSTODY RECORD Page — of <br /> Contact Person 8_o..r.1x5.31 i n Protect Info Turn Around Time <br /> Company--Lnv-ironmentril Audit Inc PO # U Normal <br /> Address 1009 A Ortega W a y City P l a c e n t i a State -LA A ZIp 9 2 8 7 0 Protect It 1232 ❑ Rush <br /> Specify <br /> Phone 714-632-.8.5-21-..... FAX 714-632-6754 Protect Name <br /> Montgomery Ward <br /> Collected By Sign — Y `� ""�'� t �– Stockton , CA <br /> t� <br /> Lab Vacuum <br /> Field Sample I D Date & Time Analyses Requested Canister Pressure 1 <br /> I � Initial Final Receipt <br /> ie <br /> -Ofor 12 :3" E BE 0 2 1 4 <br /> rl <br /> Relinqu s d By (Signature) Daterrime Print Name Notes <br /> l - (NL Q�--y z <br /> Please fax the results to Boris <br /> Refinquished By Signature) Date/Trme ed Signature) Dai rm G ( 714 ) 632-6754 <br /> Relinquished By (Signature) Dateffiime /obw�gnaturV ate7ime <br /> Ship eT Name Air Bill# Opened By Dat Im Tepp (°C).- Condition Custody Sea!;Anact? Work Order# <br /> Lab - � � A 0 aW <br /> UseTJA Yes No one NIA – <br /> Only <br /> Form 1293 rev 06 <br />