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Ti+1esW� b CHAIN OF CUSTODY RECORD Pageof_� <br /> Environmental and Geotechmca!Consultant 555 Montgomery Street,Suile 00,San Francisco,CA 94111 Ph 415-955.90401 Fax 415-955.9041 fff <br /> 2 Theatre Square,Suite 216, da CA 94563 Ph 925.25349801 Fax 92:,-253-4985 <br /> 501 14th Street.3rd Floor,Oa d,CA 94612 Ph 510-87445001 Fax 51047"507 <br /> Site Name �.� <br /> Job Number �(� Analysis Requested <br /> Protect ManagerlCon ct D:wL ZP)4viv, Je <br /> Samplers <br /> Recorder{Signature Required} No Contalners 7 <br /> Matrix &Preservative { <br /> Field Sample ,< s m _L d �� �° <br /> .r °� .. <br /> Identification No Date Time Lab Sample No s in s° � � iR� Remarks� i 'uA <br /> rt, <br /> 4 <br /> �r <br /> � t <br /> flt <br /> 2,UPbS n ture Date Time Re iv b Lure) Dale Time <br /> Jr nature) Date Timeceiv Sin uref Date Time <br /> Relinquished by (Signature) Date Time Received by Lab (Signature) Date Time <br /> Sent to Laboratory(Name) Method of Shipment 1:11-abcouner DedEx E]Airbome OUPS <br /> Laboratory Comments/Notes Hand Carved❑Pnvate Courier(Co Name) <br /> White Copy-Original Yellow Copy-Laboratory Pink Copy-Field COC Number 003300 <br /> �f�Ce1ii LAtnbi'n- � Intact <br />