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LAB -FAX RESULTS TO PARTIES LISTED BELOW. <br /> KIS'Dir, of Operations 925-831-9183 <br /> INDUS VICES <br /> Hayward Facility Mgr. 510-471-2447 <br /> 30028 Industrial Parkway S.W., Hayward, CA 94544 _ <br /> Ph: 510-471-2100 <br /> SFO-If CLIENT: —fZle of err.. e-or <br /> JOBSITE: 5�Gt1 <br /> COLLECTED BY: <br /> SPECIAL <br /> INSTRUCTIONS: <br /> CAM-17 (TTLC) -- Based on TTLC results run next SELECT THE 72hrs Standard Rate (SR) <br /> ANALYSIS appropriate test except for copper, only run an STLC if 48hr — SR + 25% Premium <br /> REQUESTED Cu's 2000 mg/kg or greater. TURNAROUND 24hrs O — SR + 30% Premium <br /> TIME DESIRED: Same DaX O — SR+50% <br /> Sample ID Lab ID Collection Matrix Notes or Sample Map, Etc. <br /> Date <br /> -�' �� `7 -,S—l�► Solid <br /> Solid <br /> Solid w <br /> RUSH '. <br /> By signing below I atte h ubmltted samples have been collected in accordance with KIS'sample directive SOP#1-B,or by other regulatory compliant means. <br /> Relinquished By: Date— �� Received By: Date . Q <br /> Relinquished By: Date Received By: Date <br /> Relinquished By: Date Received By: Date <br /> Relinquished By: Date Received By: Date <br /> SEND SAMPLE TO: Enviro-Chem, Inc. Laboratories <br /> 1214 E. Lexington Avenue REMINDER I <br /> Pomona, CA 91766 Be sure you've called <br /> Ph: 909-590-5905 Hayward to get an SFO #. <br /> Fax: 909-590-5907 Samples that are submitted <br /> CA-DHS ELAP Certificate#1555 without numbers will not be <br /> processed by laboratory. <br /> KIS CHAIN OF CUSTODY RECORD <br /> SOM-B CoC-6/04 <br />