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10 <br /> KENNEDYIJ& CONSULTANTS 41 . 0.200 Now S;q Rd #115 Bakersfield CA 93309 ❑51 So Ned Road #300 Ren 502 <br /> 0 530 South 335th St Federal Way WA 98003 336 Bradshaw Rd #140, Sacramento, rA 95827 <br /> SAMPLE CHAIN-OF-CUSTODY ANAL YSI REQUEjT ❑ 17310 Red Hill Ave, #220 Irvine CA 92714 ❑303 Second St San Francisco, CA 94107 <br /> - i ❑ 2191 East Bayshore Fid #200 Palo Alto CA 94303 ❑ 1000 Hill Rd, #200 Ventura CA 93003 <br /> POSSIBLE HAZARDS <, {s) <br /> G1 u TM ANALII'SES REt2UESTE#3 ^ <br /> Date —� ~-1'�i Report To �P��12 jLAC Y-mviP Lab Destination A Y1-A}0 <br /> t <br /> 4 <br /> Source of Samples �i i7l�r��Ll}aAe Company :L 0 S"f <br /> Address 2 '� 7fi5 r <br /> �— ALJLK Address 54 L <br /> Sampler Name ' v, <br /> Phone �J 'Z S 1 Phone <br /> Prosect No 9225 H 4a Phone '>(2 '32 1 Carrier/Way BIII No <br /> (D ' <br /> {9] {7I COLLECTION {?) 131 {4) Turn- Z Comment/Conditions I <br /> Lab ID No. Client ID No, Date Time Type Depth Comp. Pres around Ifyontairter type,cantainor number,etc.) <br /> 0 b-e a n f also <br /> leas -�C"x dvA yps" lis <br /> Pl-ec,, v _ <br /> (1) Write only one sample number In each space <br /> (2) Specify type of samplels) Water(WI,Solid IS) or indicate type <br /> (3) Maris each sample which should be composlted In Laboratory as follows Place an"A"in box for each sample that should be compoaited Into one sample use sequential letter for additional groups -» <br /> (4) Proseryation of sample <br /> (5) Write each analyses roquested across top Place an"X'in appropriate column to indicate type of analysis needed for each sample <br /> SAMPLE RELINQUISHED BY SAMPLE RECEIVED BY <br /> Print Name nature Company Data I Time Print Name 11Slgnat # Company Data Time <br /> LOGc!Ce GLIA-C �C .r 3��o GYalev1 r a _ s <br /> } 00008509 <br /> 1M{SMCUSTODy2 FOM <br /> l <br />