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CHEMICAL RESEARCH LABORATORIES, INC. • ORANGE COUNTY CHAIN OF CUSTODY RECORD <br /> • VENTURA <br /> 2325 Skyway Drive,Suite K • Santa Maria,CA 93455 • SANTA MARIA Date �Sl g8 Page_ —of <br /> (805)922-2776 • FAX: (805)922-5897 • (800)LAB-1CRL • BAKERSFIELD <br /> • L.A.COUNTY <br /> CLIENT CAI TANK TESTING • MOBILE LAB <br /> PROJECT MANAGER <br /> ADDRESS 2 N- (=E DAY10 EI• Kuse Q•6 . (LOK EN1d(P_DIJtAEVTAL,TA7c) <br /> VL3ALIA CA 2.91 PHONE NUMBER <br /> ($05� aS4-01(3 <br /> PROJECT NAME TAN K REMOVALS — /}T f SF RIGNT—OF' SAMPLERS: (Signatur ) <br /> UWj— to33 SouTd ScoTrs /�uE•� SToCICToN�ct <br /> SAMPLE TYPE <br /> SAMPLE LOCATION DATE TIME WATER AIR SOLID NO. OF TESTS <br /> NUMBER DESCRIPTION Comp. Grab. CNTNRS REQUIRED <br /> nr� <br /> 01-01 pEtocJ ucw- <br /> wcoT IR�TE FLOCR5- ooN 11516B 1INDq.1`11. �D 1 EIPA PAE-TIS <br /> 5- . <br /> rho KvAUL'1Lbt -ZFEET 115[88 12.1�PM I I) $ot5 wRSaiLS(TPt1) <br /> N <br /> S-O Z-01 Saco ecri xAelr awR .fN o) <br /> 5 -03-01 -rAtj KA i NK 90 r7 F:,=E SFtbilid 1/5188 1�:30A.M I 2)$0zDF0RS01L.S(BTx) <br /> 3)$O {kpQ <br /> lD cINA'fF.DSa <br /> o � 15 <br /> w� <br /> �CjpECII1l�A7STRAGT(gL2S <br /> Relinquished . 11(Si A) Receive y:(Signature) 30 DatelTime 4--' CRL will store sample for 30 days at no charge.Storage after <br /> days is charged at$10 per month per sample.Disposal of:,am.m� <br /> pie is charged at$10 per sample. Please indicate the disposi- <br /> Relinquished by:(Signature Received by:(Signature) tion of your sample. rT-Date/Time <br /> 1.Client retrieved by <br /> 2.Lab Disposal by <br /> Relinquished by:(Signature) Received by Mobile Laboratory for field analysis: 3.Store for days. by Date/Time <br /> (Signature) 4.Other by <br /> Dispatched by:(Signature) Date/Time Received for Laboratory by: DatelTime <br /> Method of Shipment: ,Jus di hereby authorize a perfo an of the above indicated work. <br /> Special Instructions: WALS2,E EAC14 5PAAE 43'1 ;f HE M" V SPECIFIED TESTS <br /> SIEUD LA0 RePORTS Ta LOK�VIRdJA1Eu114L =AJC SEIUD INVOICES TDCALTA►JKTesTI <br /> CCR-100 <br /> SOURCE:Adapted from U.S.EPA, 1985 <br /> DISTRIBUTION:White with report.Yellow to CRL,Pink to Courier,Gold to Sample Control <br />