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161FL190 <br /> P 0 Box 44115, Ho , TX 77210-4415 <br /> INCORPORATED CHAIN OF CUSTODY <br /> THE A S S U R A M C t OF OMIT r Novato, CA, 11 Digital Drive, 94949 ❑ Huntington Beach, CA, 5702 Bolsa Avenue, 92649 <br /> 415 883-6100 714 892.2565 <br /> Consultant's Name 61,J's- <br /> Pa e� of <br /> Address /V /,-I ` - L �rSite Location ?`/ �� ` :�CF'�- `N� A✓,-� <br /> Project # Consultant Pro ect # r 0 , 1s j Consultant Work Release# I <br /> Project Contact Phone `�/£� `�' .i }` Fax # 1`? °( Laboratory Work Release# <br /> 1 <br /> EXXON Contact P,, L1r1 �'t �'-' �❑ EE © C&M Phone# ax # EXXON RAS # <br /> Sampled b (print) 90 Sampler's Sig.­— <br /> Shipment <br /> i natSht ment Method Air Bill # Shipment Date <br /> El El ANALYSIS REQUIRED Sample Condition as Received <br /> TAT 24 hr 48 hr 72 hr 11 Standard (5 day) Temperature° C _44 e_ <br /> xa <br /> Cooler# 4fzJZIA. &L <br /> Inbound Seal Yes No <br /> to 00 <br /> V .- <br /> Outbound Seal Yes No <br /> Sample Description Collection Matrix Prsv #of PACE v A v <br /> Date/Time SolYwAter Cont Sample# 0. a COMMENTS <br /> E• W W W <br /> y L1 iJ)�,/ � 1�za Y(C) 19 Slrr�, <br /> Z <br /> I f 62,q <br /> r IV(7 <br /> / I <br /> 45 lq <br /> r, G1 l no 6, � <br /> Z. <br /> '�3 r�. W ti;7 <br /> �7rJ I�21 �O9.f <br /> Relinquished by/Affiliation Date Time Accepted by/Affiliation D to Time Additional Comments <br /> o/q <br /> Distribution While-Onginal Yellow Exxon Pink-Lab Goldenrod-Consultant Field Staff <br />