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Page 11 of 12 <br />LAIVGAIV <br />2 ,-01 <br />CHAIN OF CUSTODY RECORD <br />\ <br />Site Name: <br />Job Number: 3 ci).3(-0 <br />Samplers: <br />Project Manager \Contact: \\,) e'Ve• (22 \:>.c•I‘ <br />Recorder (Signature Required): <br />Received y: (Signature <br />/eceiyed by: (Signatu <br />Qate Time <br />Date Time <br />COO Number: Pink Copy - Field White Copy - Original Yellow Copy - Laboratory <br />555 Montgomery Street. Suite 1300, San Francisco, CA 94111 <br />501 14th Street, Third Floor, Oakland CA 94612 <br />3320 Data Drive, Suite 350, Rancho Cordova, CA 95670-7982 <br />4030 Moorpark Ave. Suite 210, San Jose, CA 95117-1849 <br />Ana ysis Requested <br />Matrix <br />Field Sample <br />Identification No. Date Time Lab Sample No. <br />T5 <br />u) <br />0 <br />cl:t--.F,(-"nz - <br />1 ± i u <br />...77—_--) • .1 k 2-'-1 kyi6 ,,-- <br />"--R - 7 — . - )— 71----A—C7 c'..``'i Lt (1 rX <br />Reli ishedlzy: (Signature) <br />-‘-' \A3Z)&) <br />Dat•i: <br />1 1 0 /II <br />Time <br />q • -as <br />Relinquished?ignature) . 7 , . _............,....- <br />Date: <br />.../c - /7 <br />TM: <br />/ C"?------' Relin hed by: (Signature) <br />t <br />Date: / 1 Imo" <br />Sent to Laboratory (Name): <br />Laboratory Comments/Notes: <br />3 <br />• <br />7). Remarks <br />T:) Silica gel clean-up No. Containers <br />& Preservative <br />Turnaround <br />Time <br />5 <br />Re77d bLab: (Sig <br />.7. <br />natLvei, <br />‘77/1/91Vr / <br /> I I Met of Ship <br />V.f <br />ment <br />land Carried <br />Lab courier ri Fed Ex ri Airborne ri UPS <br />Private Courier (Co. Name) <br />Date Time <br />>:00//7-