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CHAIN OF CUSTODY <br /> Me O-AJrli 4135 W.Sonseil-1311�ivft-A--(9 d5) <br /> 153,1 W.ZLn-23 PA-S5 QcAC> Rai 95 12L 2- REPORTING REQUIREMENTS BELOW: <br /> Efivirerrmefittal-L-at3s aa. i P <br /> Project Manager: 1' �7F![- Phone#: Z1,5PDF 1 Standard Format <br /> Email Address for Reporting:( 1,( i [ _j�p 7gg fr ,j.cc it Cell GeotraCker I EDF I Provide Global ID <br /> Email Address for Reporting: Fax m: <br /> Company Name&Address- fes,,i- P.O#I Project Name: EDD I Equis I Data Table <br /> l'?G 'i S � MDL Format <br /> Gf &,5L cy'f(C)S rojectLocation:Lolw ff,� <br /> Billing Address: Data to be reported to State's Database . Yes—No <br /> Sampler EDT I CDPH-Provide Source Codes 1 PN1S ID: <br /> u� z_8C-E SampierSignalur page of <br /> ANALYSIS REQUST LAS USE: <br /> Matrix Table: Preserved?rt,+ask yes and no it eau,avaiiable) Metals <br /> Bin# <br /> S=Soil I Sludge I Solid(circle one) Yes sttc Total <br /> A=Air ria No <br /> F <br /> DW=Drinking Water x <br /> MW=Monitoring Wells ro m U ti C <br /> GW=Groundwater E 'N U Q <br /> TW=Treated Water tjj F @ a E o@ L E 9 Microbiology <br /> WW=Waste Water - E a a" o ¢ o o ¢ ¢ q U' <br /> E c O. N '� } j E -.Y Work Order. <br /> Source SAMPLING Summa a o 0 0 E Eo o = (� <br /> SAMPLE ID: DATE TIME # (J r' c' <br /> codes- , W <br /> L j-d-l 215 s 5 <br /> og <br /> LN-3 I IS o a4 S <br /> ,4Ik �s nix 5 <br /> Ll -5 S <br /> L 1Nr-� <br /> 1-2115 —2 <br /> Lff-!j5V 0 <br /> Rel' uished� DATE TIME Receiy LRemarks: <br /> Relinquished by: DATE TIME Rec ' oratory: <br /> age 3 <br />