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PO Box 4415, DW TX 77210-4415 <br /> IH <br /> CI) RPt1RAFE0CHAIN OF CUSTODY <br /> E Ef E ASSURANCE OF o U A t i T r Novato, CA, I I Digital Dnve, 94949 ❑ Huntington Beach, CA, 5702 Bolsa Avenue, 92649 <br /> 415 883-6100 714 892-2565 <br /> Consultant's Name/ 6—A Fr,JG-/IFF <br /> Address , /if� Pae of Z. <br /> ��/ �_/�i� r7 �L e_ Site Location �7'`%�� � F.:<-�vG A✓r -� <br /> r/ <br /> Project# Consultant Pro ect # <br /> i�, j r'! Consultant Work Release# -VV <br /> Project Contact Phone# ' ;/O 4Fax # yy S'7 Laboratory Work Release# ('16 731 0 <br /> EXXON Contact !�� 'L� C' �'� '�❑ EE © C&M Phone# ax # EXXON RAS # 3 <br /> Sam led b not -D (C L- S/7 Sam ler's Signal-, <br /> Shipment Method Air Bill # Shipment Date <br /> ANALYSIS REQUIRED Sample Condition as Received <br /> TAT ❑ 24 hr ❑ 48 hr ❑ 72 hr ❑ Standard (5 day) Temperature° C <br /> Cooler# <br /> W o Inbound Seal Yes No <br /> 00 <br /> .. Outbound Seal Yes No <br /> Sample Description Collection Matrix Prav #of PACE v 0 G o0o <br /> Daltrrime 5oil/Watcr Cont Sample N < x 44x Q COMMENTS <br /> W 0 W <br /> �z1125 zC) �C <br /> I fly � <br /> r <br /> �JY- <br /> 1 <br /> I <br /> Relinquished by/Affiliation Date Time Accepted by/Affiliation Date Time Additional Comments <br /> Distribution White Onginal Yellow- Exxon Pink-Lab Goldenrod-Consultant Field Staff <br />