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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 Datez�Q Page_of <br /> (805)922-2776 • FAX: (805)922-5897 • (800)LAB-1CRL • BAKERSFIELD <br /> • L.A. COUNTY <br /> • MOBILE LAB <br /> CLIENT 5 <br /> F PROJECT MANAGER <br /> ADDRESS D L)jp g k LIS, G• LOP I uN E✓rA� AK• <br /> VIS L PHONE NUMBER <br /> (3;tC>D re59-ol13 <br /> PROJECT NAME TAPK 17_&moUALj -Are 5r 1--6P- G,/try SRS: (Signature) oect yP Is gy <br /> /o33 -300001 Sco T/S ADM. Sj`bc K -ONAMP� I CA. ( R e'• <br /> SAMPLE TYPE <br /> SAMPLE LOCATION DATE TIME WATER AIR SOLID NO. OF ESTS <br /> NUMBER DESCRIPTION Comp. Grab. CNTNRS REQUIRED <br /> S -may-o l TAPie 03 -2 cAsr PEcow EPA M1etho)s; <br /> Is, 'L 54 G 88 99,41'1 l 0 A015 /=Df t,iLs <br /> pS-O� TAuK-I#3 _ a1 <br /> _r <br /> BL`s r ' a) Qo26 role SOIL$ C arx) <br /> O.Eu / 6 P //;9Yr<irr 3 S�OIo �c LO). <br /> Relinquished by:(Signature) Receive by:(Si nature) DatelTime <br /> CRL will store sample for 30days at no charge.Storage?Ream 1 �� <br /> r days is charged at$10 per month per sample.Disposal of Sam- <br /> . pie is charged at$/0 per sample.Please indicate the tlisposi- <br /> Relinquished by:(Signature) Received by:(Signature) tion of your sample. DatelTime <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 DatelTime <br /> (Signature) 4.Other by <br /> Dispatched by:(Signature) DatelTime Received for Laboratory by: DatelTime <br /> Method of Shipment: Rr r e I hereby authorize the peknNnce of the above indicated work. <br /> Special Instructions: A)jALyze EAu+ SAw1P4E OY F Fbun 5Js"F-14 1 fasts. <br /> Euo 4AA A6p&ffZ To L&K E UI auu uT L C SE Te Cotrill 1 K t ru <br /> SOURCE:Adapted from U.S.EPA, 1985 CCR loo <br /> DISTRIBUTION:While with report.Yellow to CRL,Pink to Courier,Gold to Sample Control <br />