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KENNECY/JENKS CONSULTANTS ❑200 New Stine ftd.,0115,Bakersfield,CA 93309 136190 Neil Road,#300,Rano,NV 89602 25 0 <br /> ❑530 South 338th St.,Federal Way,WA 98003 D 3338 Bradshaw Ad.,0140,Sacramento,CA 96827 <br /> SAMPLE CHAIN-OF-CUSTODY ANALYSIS REQUEST ❑17310 Red Hitt Ave.,0220,Irvine,CA 92714 >15-.3 Second St.,San Francisco,CA 94107 <br /> Q (32181 Ent Beyahwe Rd.,0200,Palo Alto,CA 94303 ❑1000 Hill Ad.,0200,Ventura,CA 93003 <br /> POSSIBLE HAZARDS: f Q4" <br /> ANALYSES REQUESTED <br /> Date Iy�JQa.�c�^ ���I � Report To fl : �eK"^gP --- Lab Destination CA'r., L _ <br /> r <br /> Source of Samples X4>1( �oh n rs Company K�-1 Address <br /> _ l - <br /> 9: 95112b4 REP; GC <br /> Sampler Name / tkx, --� Address ;?,,6 Iott <br /> r e ctlENr: KJ-SF I <br /> Phone NO 2�3-25� �,Ir , CA iqic,2L d Phone DUE: 11/23/95 <br /> �$oo?3 , D .� PN sem) 743-il so % t , (A �Er 9:25039� <br /> Project No hone CarnerlWay BIII Nt <br /> »;Itl Mil COLLECTION -121' <br /> .. (3l.: (41f: Turn ;Cummeiit/Condition9. <br /> I <br /> Lab`ID No Chant'ID No Date.,I.Tma, Type Depth C Pres;'-around C— typ ! <br /> ortA, IContatner a contalner;rtttmber:eto <br /> KU3+ 1�1+ 0 X rt I — j1fi��r�C �v j�c rMecr stec 1 .1;4 <br /> 61 - R lord X <br /> Koi - 15 II�� # 5 X X <br /> 82 � �.5 � IY° zf S X <br /> X X <br /> K6it— 4_5 1300 4.s X X <br /> 0q- 130 X <br /> �'j}L) - 1 t�(, 1 31k-11 ,rfeP j /le� <br /> (11 Wr"only one sample number in each space. <br /> (2) Specify type of sample{s): Water(W),Solid(S),or Indicate type. <br /> (3) Mark each sample which should be compositod In Laboratory as follows: Place an"A"in box for each sample that should be composited Into one sample;use sequential letter for additional groups. <br /> (4) Preservation of sample. <br /> (5) Write each analyses requested across top. Placo an"X"in appropriate column to indicate type of analysis needed for each sample. <br /> SAMPLE RELINQUISHED BY: SAMPLE RECEIVED BY: <br /> Print Nemo Signature f omppny pate Time Pnnt Name: Sigftattae :',Co!nPanY Da6e taime` <br /> %MISLICUSTODY2 FDM <br /> 000006.00 <br />