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Company Name/Addres,. Billing Information: Chainaf Custody Page i.of2� <br /> Fulcrum Resources Env - Monrovia, CA Don Kellar/John Winkler Pres <br /> 415 W. Chestnut Ave. Chit ace Analytical® <br /> Mo Chestnut Ave. Monrovia, CA 91016 <br /> Monrroo via,CA 91016 i' <br /> i <br /> Report lo. Email To: _ _ uas In,n"as uo,,t win.to gnzz <br /> Forest Kan forest@frenviro,mm;ian@frenviro.com O wbompenga um(Aemma<Ivnui<mmW <br /> el nomwinesaQMwledgment and a«emanne of the <br /> Project Description: - City/State aTbLK*a..y Ch Please Circle: Cut m exe*e^n,andc anoml-nee. <br /> u<v<ll mona< e<.o„ymmnlca..aandam <br /> u<ira m <br /> Collected: y PT MT CT ET �O an S = <br /> Phone:805-338-8008 IClient Project If Lab Project# z, o 0SDG If <br /> ►b -Qbs6 FULRESMCA-FOREST 0 °�' E U -.. <br /> _ g S $ d a = E030 <br /> = <br /> Collected by(print): Site/Facility ID# P.O.# C Z Z on o <br /> f_0wst Kun N� ZOt10� '�66 U O 2 d G ACCtnum:FULRESAttA <br /> Collected jj re): u O O S E Template T191696 <br /> Rush? (Lab MUST Be Notified) Quote# 9 V c M U O p <br /> Same Day Five Day 6 W e^-I ? O Q d p Prelogin:P861801 <br /> _Next Day _5 Day(Rod Only) Date Results Needed ~ aS .aa U l.3 UD PM:546-Jared Starkey <br /> Immediately Two Day _10 Day I Rad Only) No K /— Q OE .0 0 K <br /> 00 <br /> Packed on Ice N_ V _Three Day of Q Q pV a .� O t7 > PB: ._.___..—._______ <br /> V V J0 3 Shipped Via: <br /> Sample lD Comp/Grab Matrix' Depth Dale Time ntrs of of to 00 m m m ,c.ra,k, Sample d lab only) <br /> --_—. --- O t9 2 > v 3 3 3 <br /> sBt 5 - Ss i o F)c DLD —L2 <br /> ss to (o �I o IC, v K rt0'1 ^Q2 <br /> Ss S (o LI pSIS x 'A —� <br /> S6i '20 (� ss 20 L al p Z� y fiLP 0 <br /> ttioLp <br /> SSZ IT -GWryt 15 U`100 <br /> S0L'z° 6 ss-'Gvr-,I� so 0CII L } Ftot D 017 <br /> L S54rff'--ti S Ogti t4q /_ <br /> hoLkD <br /> - -a83Jy - G ss 9 ot4s ( koLp —G <br /> C,S 3-- LS -. ..._ SS t$' o1so X ( c <br /> 'Matrix: Remarks: Sample Receipt h ck igt <br /> SS-Soil AIR-Air F-Filter pH Temp COC Seal Present/intact: NP Y N <br /> GW-Groundwater B-Bioassay COC Signed/AccurateBottles arrive intact: _N <br /> WW-tanking at Flow Other__ <br /> DW-Dfinkl0 Writer Correct bottles used: y/Q N <br /> g Sufficient volume sent: N <br /> OT-Other Samples returned via: Tricking# 7 Q 11 X 0A 1 2 Lj(,/ <br /> UPS FedEx Courier V (✓ It alce: able <br /> VOA Zero Headspace:� Y N <br /> Relinquished .(Sign re) Date: Time: Recei ed by:IS at Trip Blank Received: Yes No Preservation Correct/Checked: Y/ N <br /> Hl MsoH RA R/hr: �D Screen a0.5 m 'y _N <br /> TBR <br /> R e— d b)(Signatu Date/ % Time: Received by:(Signature) Tempr3 E Octlies Received: If preservation required by Login:Date rime <br /> Relinquished by:(Signature) Date: Time: Reseiveed for lab by:(Signature) Date: ''t Time: <br /> ^/l Hold: Conft 0 <br /> ait Sac �'L'M.cj at/11111 V"lW I <br /> NCF 1(0jlr <br />