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•� ) Q LC I <br /> APTIM <br /> n CHAIN OF CUSTODY f LABORATORY ANALYSIS REQUEST FORM Page-, of'_----- <br /> A P T I M APTIM Environmental& Infrastr-ucture, LLC PQ NUmber: PCARD <br /> 4005 Port Chica ro Highway,Shite 200,Concord CA 94520 Lab: <br /> Prnjrri 'tiurne-, T1t1'c.r-'T'racy,CA � Analysis Requester) <br /> A17'It1-1 €i-oject Nntsliiel: 723019111 — <br /> P1)F Report to. Jody Rhoades � <br /> Email: Jocly.Rhu:ldesCaxptim.coltl a' <br /> Cell Ph:530 933 8265 0 <br /> CCS Report to: <br /> r o 0 <br /> C, <br /> Sampler's Signature: <br /> - <br /> r. F h REMARKS <br /> Sample LAli Sample f.wwincr ivpes <br /> 1.D. J Date Time I.D. Matrix Yrr�ersaunn, <br /> sp // a r I I <br /> 5jO 30 <br /> ftlil.l [)l• F 1 1tE:('f';11 F:I E31 f 1tF:i.f\Qt fti11F:1)E31' RL•'C I.,1VI I)BY Tl-RNAROUND lil:1'[)1t'I'RI:Qf IfZF.�!l:ti7:ti <br /> IiE:C]t lHI:]!!:ti'I:S X I Roulirx Report <br /> S._nate a Signnhlre Sl&natLLrC Sipoaturc X aaln _as hr _+ds [], ltuport[includes IlIj11.A-IS <br /> `DC7�1 C� Sl+urdnrd{-u1-1S,cmkol:dans <br /> t I Msl),a5 rCqlllrlYl,Ill:.iy be <br /> Printed acne 1'rin rd Namc Primed.Nano Printed Numv, 1'rm,llrvuhn]111A Mmy R-lik, charge()us samples} <br /> I'rn.idc irAX Neemiav}•RL�atic III Data Valfdaticm Report <br /> Firrn Alan Firns Firmu•nrrtlyda-�mnl)-„• (mel dcs!1]1 Riw Data) <br /> APTIM RWQC II <br /> I W&I'inlc�J.f -1-";Ar) daterriTile DatulTintc iMIX\1PQI.,-VI'RAC F#) <br /> Rlw1 NCii]ISlliu)Ely I1LcvIvF.1)11V Specisd 111struainnsl['omiocrles: <br /> Silnalure siollalurc C 0 <br /> Printed Name 1 dnlcYl.tiarae'r' J <br /> f5 <br /> I]alc1l imc Firm Firw <br /> I]atc11•inlc <br /> Page 19 of 20 <br />