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Moo" 1111111101111111 <br /> N DATE CHAIN OFCUST UMBER <br /> a ��� 2614 indu.b I Ave.,West Seenuneeto,CA.95891-138(910)8721393 <br /> CHAIN OR <br /> OF CUSTODY RECORDFN 1 d 2-L/ <br /> � <br /> A Cornus Company F Lhumin wiry,Baden Gro",CA.92641-1432(714)M4370 LAB NUMBER <br /> $ P y ❑16501 Eesti Gde Are.,City al MdusNy,CA.91748-1321(816)985-1008 7 <br /> 0 MoW*L.D.,1(s00)ENSEco-8 Page___--4 of <br /> CILIENT 4- <br /> PROJECT MANAGER <br /> SEC pip �� `/41e� <br /> ANALYSES <br /> ADDRESS TELEPHONE NUMBER(AREA CODE) <br /> 3y 3 s rcfrf (y& ) VS-&- <br /> ISTATEt ZIP E SITE CONTACT <br /> cT e-k rc,/Y e,t to C/1 /s�i/ /-MIll-W1� <br /> PROJECT NAME TELEPHONE NUMBER(AREA CODE) ]1 <br /> A1002- (o-001- 01 29 G - 96103 \ <br /> CONTRACTMURCHASE ORDERIQUOTE NO J� <br /> SAMPLE TYPE No of . �� <br /> SAMPLE NOADENTIFICATION DATE TIME LABISAMPLE Co"- b Semple CDndltion! <br /> NUMBER u4 AIR O TAMERS REMARKS + <br /> 102119q -14W-1 101 !s X 1 <br /> /0 2119y-MW-2 ruz x I >r <br /> Mw-3 lv mx 1 k <br /> ~4 lu 13 X I <br /> 102 5q-low--5- 10 <br /> /02y1 - mw- la I° Z1 X x <br /> D Z - 10 <br /> � y9 Mw- <br /> DO THE SAMPLE(S)POSE ANY POTENTIAL HAZARD(S)?IF YES PLEASE EXPLAIN +1 <br /> 0 <br /> BAM '� /Pr t REUNOUIBHED 13Y(SIGNATURE) 1\44ft <br /> �D BY( IGNATUR DATE TIME a delivery of samples and the signature on this chain of ' <br /> ' /V custody form constitutes authorization to perform the analy- <br /> RECEIVED BY(SIGNATURE) DATE TIME RECEIVED BY(SIGNATURE) DATE TIME sirs specified above under the Enseco Terms and Conditions, ' <br /> unless a contract or purchase order has been executed and + <br /> RECEIVED FOR LABORATORY BY DATE TIME DATE TIME lS Sited above <br /> �� RECEIVED �0 ACCEPTED AMPLE DESPOSITION• <br /> /0 N I 1 Storage time requested days <br /> METHOD of SHIPMENT j (Samples will be stored for thirty(30)days without additional <br /> charge, thereafter storage charges will be billed at the pub- <br /> SPECIAL INSTRUCTIONS lashed rates) <br /> C,4 LL /✓//o /,, �t L� /�J�� �,� � � � d Sample u re returned to client ❑Yes D No of (15 00 o iwill <br /> s- <br /> L I�Cf'1 dispose of unretumed samples for a charge of$15 00 Dis- <br /> __,,cc,, posal will be by incineration wherever possible,otherwise,as <br /> it <br /> &A/ s appropriate, according to legal requirements) <br /> DISTRIBUTION-WHITE with Report;CANARY To ENSECO,PINK-To Courier,GOLDENROD-TO Semple Contra) <br />