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r , <br /> CHAIN OF CUSTODY / ANALYSES REQUEST FORM f/ _ <br /> SAMPLE COLLECTOR: R�KVJt� <br /> CT NO.: SECTION N DATE: SAMPLER'S INITIALS: SERIAL NO.: M <br /> Ci4080 Cavitt Staliman S.Rd.,Suite 700U�i OZ (� (/d� f( —Z' —C?j 7 _ jY �Granite Bay,Cali(omia 95746-9460 T NAME: SAMPLER(S e}; ""s CEVINE•FRICKE 9'!6 786.0320 Fax: 916 786-0366 tvis r-rr`� ,c {e. /-4 <br /> 1( <br /> SAMPLE ANALYSES <br /> (' $ REMARKS <br /> F, <br /> TYPE ory� 6rya� off,®A i'��}�/ TAT °VOCs: °'Metals: <br /> Paory'`�P06°�Q ❑ 8260 List ❑ CAM17 <br /> a Q QAl ¢ 9 G a ❑ 8240 List ❑ RCRA <br /> Sample D. Date Time a��aF oo a`w` Qra Q�aa�kjao�s�°a5 �( aaa` 52 �O ❑ Bolouse ❑ LUFr <br /> �. c� 5 SY 4 0 J �` 0� QJ ,Z� ❑ 624 List <br /> �llc—°13 00 IDIL&�b �! <br /> P,L iGa--/�— O'2c-o lvgb R `.� X X I D Gt�ej o <br /> l6—%5—OIC trZv-D31C�1�-� o� X � VtC. '1`LG � <br /> ANT <br /> rs, <br /> U ff)ER car, <br /> e <br /> tj <br /> 2 0 2 C3 () u1 <br /> 1 p <br /> 0J <br /> I <br /> SAMPLERECEIPT: Caaler Temp: gDOFENT: RELI Q HE BY: RELINQUISHED BY: 2 RELINOUlSHED BY:Intact Q Cold .-_-' _4 Cooler No: (SIGN((CURE) (DATE) (SIGNATURE) (DATE) (SIGNATURE <br /> ❑ On Ice ❑ Ambient r CS t P✓f" IWO > 7 (DATE) t .( <br /> ,l <br /> Preservative Correctl FAX COC CONFIRMATION TO (Pa1t7fED NAME)// rr'^^^'�a%% (TIME) (PRINTED NAME) (TIME) (PRINTED NAME) (TIME) <br /> ❑ Yes ❑ No ❑ N/A �G(j/nF•SGI ^'/.�.. <br /> COMPAN COMPANY C C—ENV (.., <br /> ANALYTICAL LABORATORY: FAX RESULTS TO: RECEIVED BY: t RECEIVED 0Y: 2 RECEIVED BY(LABORATORY): 3 <br /> ��vsreS u116I•z X <br /> SEND HARDCOPY TO: (SIGNATURE) (DATE) (SIGNATURE) (DATE) (SIGNATURE) <br /> (DATE) 'G., <br /> (. SEND EDD TO:. (PRINTED NAh1E) (TIME) (PRINTED NAME) (TIME) .. (PRINTED NAME) <br /> EMVi ABEDDS.COM < (TIME) 4 <br /> COMPANY COMPANY St if r,A;Citi, <br /> Lab/Shipping Copy (White) File Copy (Yellovr) Field Copy (Pink) LABORATORY `, <br /> FORM NO: 2001COCISXS <br />