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t I I 1 1 1 1 I I I 1 1 1 1 1 ( I 1 <br /> �© North State Environmental Analytical Laboratory <br /> Chain of Custody/Request for Analysis (415) 588-9652 <br /> Client: Phone: (415J Report to: Turnaround Time <br /> A/ S E cc �_� 5. ��r p�� STaO <br /> Mailing Address: G10 S.S f(V C{, Sj Sic_ W Billing to: 8 Hr 24 Hr <br /> SSP CA a�-towo Sg <br /> 40 Hr 5 Days I <br /> Site Address: PO# / Billing Reference: <br /> � <br /> Sampler: Date: {' c -10 y Other I�/IZ�Q� l <br /> Sample ID: Sample Description Container Sampling <br /> # / type Time/Date TPH-D TPH-G BTEX O+G Remarks <br /> sa les �.^ru in ice. <br /> Ap )ropcc — <br /> Relinquished by. Received by: d ,f/ Yes No <br /> Y /l�lUl/ it es_ kl <br /> iWere samples <br /> Received by: <br /> Relinquished by: , � , F Q t�. Time` 'reserved ? <br /> Tim _f7 Received in lab by: In good <br /> condition <br />