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KIS CHAIN OF CUSTODY RECORD i <br /> SEND RESULTS TO ALL PARTIES LISTED BELOW. ' <br /> Fionn O'Neill Fionn@kleenblest.com' <br /> Industrial Services <br /> 50 Oak Court,Suite 210 Ifertt Enter Your Name,Here y10vrl:%*#1 Et i r #�Tere <br /> Danville,CA 94526 ( i1vt k4- <br /> Phone 925-831-9800—Fax 925-831-9183' <br /> i <br /> ti <br /> C41ECTED,.BYr �GS � <br /> SPECIAL <br /> INSTRUCTIONS. <br /> y. <br /> ww. 3 <br /> Y <br /> CAM 17-TTLC,STLC 11 OX MULE,T+CLP as needed , 0-7 TRE h472h ard ate <br /> Lly- <br /> 8 8 Metal TCLP 48hrs SR+26% Premium <br /> 17 Metal STLC Tl �" B ' 1 1 24hrs 5R+30% Premium <br /> Other Note In Special Instructions Section AINt OB <br /> ( ) P IiIIBHL IC NTIIitt3} ( ) Same Day SR+50% <br /> Sample ID Lab ID Collection Matrix Nates or Sample Map, Etc, <br /> Date <br /> f� ..r, 1=z i. Solid <br /> Solid <br /> Solid <br /> By my signature below attest that this sample was collected in accordance with KIS'sample directive SOPg1-B o other regulatory compliant means. <br /> iReN pate 5�2S�Z( Received By: Date <br /> &`Time &Time <br /> h.�42 <br /> . .: <br /> Relinquished By: Date Received By: Date <br /> &Time &Time <br /> Relinquished By: Date Received By: Date <br /> &Time &Time f <br /> s <br /> Send Sample To: Enviro-Chem, Inc. Laboratories <br /> 1214 E. Lexington Avenue <br /> Pomona, CA 91766 <br /> Ph: 909-590-5905 1 <br /> Fax: 909-590-5907 i <br /> CA-DHS FLAP Certificate#1555 <br /> i <br /> CKIS DOMRccycling DocACoC1090928-01 CoC Slandwd.dac <br />