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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 i–8-P Pageof—/ <br /> (805)922-2776 • FAX: (805)922-5897 • (800)LAB-1CRL • BAKERSFIELD <br /> • L.A. COUNTY <br /> • MOBILE LAB <br /> CLIENT �- -S <br /> ADDRESS 2oa N. S PROJECT MANAGER <br /> K1- <br /> Vk5ACi� C-'4 <br /> CtD E c <br /> 3 9 PHONE NUMBER <br /> dos)-6 5-9- <br /> PROJECT NAME TAN K KEM,0111k S–.ArfSF /?-16Ji T-Or-GUAy tf ture) <br /> 1033 S00044 SC0TTSAr= <br /> b , 57DCXTm-)/cA . <br /> SAMPLE TYPE <br /> SAMPLE LOCATION DATE TIME WATER AIR SOLID O. OF TESTS <br /> NUMBER DESCRIPTION Comp. Grab. CNTNRS REQUIRED <br /> S-06-0I y - P 167f 32- EPA � � �.• soitsc H <br /> oto SO;Ld Fon sous C BTXJ <br /> 3 to <br /> W �cj3rr <br /> ReImqu' hed by-(Signature) Received by:(Signature ate/Time <br /> CRL will store sample for 30 days at no charge.Storage after 3- <br /> days is charged at$10 per month per sample.Disposal of sam- <br /> ple is charged at$10 per sample.Please indicate the disposi <br /> e inquished by:(Signature) Received by:( tion of your sample. 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 Dale/Time <br /> (Signature) 4.Other by <br /> Dispatched by:(Signature) Date/Time Received for Laboratory by: DateITime <br /> Method of Shipment: I hereby authorize the perfornnanqp of he above indicated work. <br /> Special Instructions: AA*`)(z,5 •49CA SkwtpLE /oyt4/-= FOlut f!-Y Jfi rF52 L <br /> SOURCE:Adapted from U.S.EPA, 1985 CCR 100 <br /> DISTRIBUTION:White with report,Yellow to CRL,Pink to Courier,Gold to Sample Control <br />