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M(861tf one CHAIN-OF-CUSTODY RECORD MOL: <br /> l_ABORATOFItES INC Date: Q Page of a. <br /> 148 So. Vinewood Street, Escondido, CA 92029 (619) 735-3208 FAX (619) 735-2469 816 Church Street, San Francisco, CA 94114 (415) 920-9972 FAX (415) 920-9983 <br /> Client: � e4t/ 7�- Turnaround Requested: <br /> Analysis Requested <br /> Site Address: ' 0 A 1"07e Roac/ xOnsile/24-48 hrs. <br /> ❑ Offsitc <br /> ❑ Other <br /> Project: CO3`�' <br /> Sampler(signature): i� 01 O� Few 1°� Off' o� <br /> Sample ID Date Time Location q)ti ,� <br /> Alio � <br /> s i <br /> 1-rs � <br /> W <br /> 1 io/s 1 <br /> Pit 5 / 35 x <br /> - 7 /oy x s 2 <br /> loll5- <br /> _ 1 x 5 <br /> I Ix s r <br /> xMINE L01 an 0 11-� s 1 <br /> Date: " ; Date: p Datc: Sample Receipt Spe Inst etions <br /> Signature:* Signature:* Signature:* Int*Ct: <br /> Printed Namc: ') I k mg Printed Name: 'Time: Printed Name: Time: YCS No <br /> Company: .4 / Company: Company: Seal Intact: <br /> " Datc: Date: Date: Yes NO CN/ <br /> 5ignalure:* signature:* Signature:* cold: <br /> Printed m� tin Prinlcd Name: T11i7C Printed Namc: Time: s No <br /> Company: Pe-7 Company: Company: NSA ( eCeived on site) <br /> *Si nature consiilutes authorization 10 proceed with analysis and acct lance of conditions on hack. <br />