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EXXON COIF ANY, U.S.A. <br /> P 0 Box 4415, Houston, TX 77210-4415 <br /> Pa <br /> C0RP0RArFo � CHAIN OF CUSTODY <br /> t H i A SSURAOICE OF QUALITY Novato, CA, 11 Digital Drive, 94949 ❑ Huntington Beach, CA, 5702 Bolsa Avenue, 92649 <br /> 415 883-6100 _______(?_141_892-2565 �J <br /> Consultant's Name !~ � Pae of/�- <br /> Address /! L•12 Site Location <br /> Project a Consultant Project N � �7 r 2� L���' Consultant Work Release b e 7-14e <br /> Project Contact nJ' 0 AA`~ Phone H / 7 Fax b Laboratoll Work Release a q Vo� o <br /> EXXON Contact I�'—vA GJ6,J't-fP-[1 EE ❑ C&M Phone 11 Z Fax b EXXON RAS # <br /> Sampled b not 1 ,C PCC ler's Signature <br /> Shipment Method Air Bill NT Shipment Date <br /> TAT ❑ 24 hr ❑ 48 hr ❑ 72 hr ❑ Standard (5 day) ANALYSIS REQUIRED Sample Condition as Received <br /> Temperature°C <br /> Cooler b <br /> W Inbound Seal Yes No <br /> Outbound Seal Yes No <br /> U11 14 <br /> Sample Description Collection Matrix Prsv #of PACE 6 0A 0 <br /> Dolt/Time SoiVWatcr Cont Sample N � <br /> qt COMMENTS <br /> I (�• W �" W [� W � <br /> Relinquished by/Affiliation Date Time Accepted by/Affihation Date Time Additional Comments <br /> Mbinbution White Onginal Yellow- Exxon Pink-Lab Goldenrod-Consultant Field Staff .4 <br />