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f; <br /> I <br /> KIS CHAIN OF CUSTODY RECORD <br /> SEND RESULTS TO ALL PARTIES LISTED BELOW: <br /> Fionn O'Neill Fionn@kleenblast.com <br /> Industrial-Services <br /> _ I <br /> 50 Oak Court, Suite 210 Client Enter Your Name Here .Xour x#lEmaffffb ; <br /> Danville, CA 94526 / , <br /> �t +Phone 925.831-9800 61 Fax 925-831-9183 K� �ii/ll�1+R Pir v r <br /> SPECIAL <br /> INSTRUCTIONS; <br /> CAM 17-TTLC, STLC 10X RULE, TCLP as needed SELECT THE,_.q , 72hra Standard Rata f <br /> ANALV$$' ( ) 8 Metal TCLP T{ N.Ikl-0 ' o <br /> ( ) 17 Metal STLC 7'1tVti t7ES1R ) + S to premium <br /> 0% Premium <br /> ( ) Other, Kota in Special Instructions Section MI( N /C�'HT1NGz } Same .a R.+50% i <br /> Sample ID U0SID Collection Matrix Nous or Sample Map, Etc. <br /> Daae <br /> t Mt <br /> Solid <br /> Solid <br /> . Solid <br /> y <br /> By my signature below I attest that this sample was collected In accordance with KIS'sample directive SOP#1-B or by other regulatory compliant means. <br /> F±eftltutstl`B {, T Date 5��j� l Received By: Date;� � <br /> �... : &Time <br /> &Time <br /> Relinquished By Date Received By: Date <br /> &Time &Time <br /> - i <br /> Relinquished By: Date Received By: Dale i <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 /> QWIS DOMRecycling DucslCo0090928.01 CoC Standard doc <br /> r <br /> i <br />