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KIS CHAIN OF CUSTODY RECORD <br /> SEND RESULTS TO ALL PARTIES LISTED BELOW., <br /> Fionn O'Neill Fionn aU� leenblast.com <br /> E <br /> 50 Oak Court, Suite 210 Client Enter YourNarrte.Nere YaurFar#/ErihalEHere <br /> Danville,CA 94526 Mid MWH114yI R <br /> Phone 925-831-9800-Fax 925-831.9183 <br /> Fr -�1 1 G tE1±ITx 90S.Tfl�a <br /> turrr[� r:.�1"�1- Y t� G4IS � - Jtt1� S Svt UT(ONS <br /> . <br /> Ac <br /> SPECIAL <br /> INSTRUCTIONS., <br /> CAM 17-TTLC,STLC 10X RULE, TCLP as neededSOLECN 72hrs Standard Rate <br /> ( ) 8 Metal TCLP 48hrs SR+ 25% Premium <br /> 17 Metal STLC TWE O SIREL?BY ( ) 24hrs SR+ 30% Premium <br /> 111ARKINt3 OR <br /> ( ) Other, Note in Special Instructions Section ,tl' tL - T/NG ( ) Same Day SR+60% <br /> Sample ID Lab ID Collection Matrix Notes or Sample Map, Etc. <br /> Date <br /> Solid <br /> Solid <br /> Solid <br /> By my signature below I attest that this sample was collected in accordance with KIS'sample directive S013#1-8 or by other regulatory compliant means. <br /> 3 <br /> lel i{uf, dty ' Date S s�� Received By; <br /> Ctate <br /> :r <br /> l Time 4 , d Time <br /> Relinquished By: Date Received By: Date 3 <br /> &Time &Time <br /> Relinquished By: Date Received By: Date <br /> &Time &Time <br /> Send sample To: Enviro-Chem, Inc. Laboratories <br /> 1214 E. Lexington Avenue <br /> Pomona, CA 91766 <br /> Ph: 909-590-5905 <br /> Fax: 909-590-5907 <br /> CA-DHS ELAP Certificate#1555 <br /> CAIS 17OMRccycling DocsWoO090928-0 I_CoC_Standard,doe <br /> a <br />