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: • . .• ' iAiN CF CUSTODY RECf '"+j <br /> SAM PL S.{sign ure I} <br /> -SHIPPINGINFORMATION <br /> Phone: 1 <br /> tn Shipper _ Q in f_W <br /> i ( } <br /> Address <br /> Date Shipped <br /> Shipment Service <br /> Airbill No. <br /> ATTENTION: Cooler No. <br /> Phone No. <br /> Relinquished by: (Signature) Received by: (signature) Date/Time <br /> Relinquished by: (signature) Received by: (slgniture) Date/Time <br /> Relinquished by: (signature) Received by: (Signature) Date/Time <br /> 0 , <br /> n <br /> Reli u)shed 7: ( gnat Receive les t 6r:(signature) ate/Time <br /> * Analysis laboratory should complete. "sample condition upon receipt"I sectf below, sign and return top copy to <br /> J. H. KLEINFELDER & ASSOCIATES. 1901 Olympic Blvd., Suite 300, Walnut Cree . California 94596 <br /> Sample Site Date Analysis Sample Condition <br /> Number identification Sampled Requeste6 Upon Receipt 1 <br /> -�s 5 V4, �2g- .5 A 4195'.1 <br /> Ci <br /> Ul <br /> 4 <br /> LAB INSTRUCTIONS: Laboratory reports -reference and be billed by site IN and contain the following: <br /> (1) summary of analytical methodology and QA work (blanks, spikes, duplicat11 es) <br /> (2) dates for (a) sampling. (b) lab receipt, (c) extraction, (d) injectionyanalysis <br /> (3) detection limits for all constituents analyzed for and reporting of all constituents detected which were not <br /> specifically designated <br /> I �^� <br /> (4) ` 1 i[ y, a� S5 V�IC [y C <br /> II ci <br /> �• ('�_�_�CCL rI <br /> White - Sampler Canary - J. K. Kleinfelder & Ass oc_iates r _ Pink - Lab Courtesy Copy <br />