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SROYMER TECHNOL OG Y. INC. CHAIN OF CUSTODY RECORD <br /> Analytical Laboratory Phone:(916)362-8947 C.O.C. No. 20981 <br /> 3050 Fite Circle,#112 Sacramento,CA 95827 FAX: 916)362-0947 Page.,--L of Z---L STAL Invoice Number: <br /> Company: Phone: ANALYSIS REQUEST <br /> Project Man 2er: iul ;? <br /> Z-d / (�e-e /S FAX: REMARKS: Sampler's Name: <br /> Report Addre!Ss. <br /> Billing Name&Address: <br /> mc~ 4 ,'Atz ( A CW; �, 3 All None Some <br /> Project Name:AC & I I Project/Job#: 7 �LC>13 2— . 0CeOK OK OK WET(STLQ <br /> Cooler Tern <br /> Project Location: Y4'DC k P0* 0,1 If Vo .f Sample Condition TCLP <br /> pH <br /> Preservative TCLP Total <br /> Sampiing Container Used Matrix TAT— <br /> C14 C\1 <br /> 00 z <br /> Go <br /> a. <br /> to <br /> U) (L <br /> C\1 <br /> E <br /> cli <br /> A? UJ 0 <br /> 00 0 <br /> 0 cm cli 0) <br /> 4w —M, 0 IR <br /> w a. 0 o- <br /> C/) n A Z 0 1 C\J C\1 U) <br /> E - co 0 8 0 <br /> E w E X w w <br /> C-5 UJ UJ <br /> L; 1 <br /> o< d< 0<5 0<- o< 0 LM <br /> NO. I SAMPLE 10 Date Time I CM I I I <br /> PVT- P) 1-4 l-30 CD UJ w w w UJ w z 0 cc cr 1Iw <br /> 2 MST- P2 110 <br /> 3 53T- <br /> 4 CbS T - pq <br /> 5 P85T050 . <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Relinquished by: by: Relinquished by: Received by: <br /> I13 1 IT Date: "/ Time: Date: Time:=me. Date: Time: <br /> Date:e: Time: I <br /> 01 PAC= OCAM nclfrMeC C'Mr <br />