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0 <br /> TreadweIEMlo CHAIN OF CUSTODY RECORD Page of Z <br /> Environmental and Geotechnical Consultant K11 555 Montgomery Street,Suite 1300,San Francisco,CA 94111 Ph.415-955-90401 Fax:415-955-9041 <br /> 2 Theatre Square,Suite 216,Orinda CA 94563 Ph:925.253-49801 Fax:925-2534985 <br /> Site Name: <br /> 501 14th Street,3rd Floor,Oakland,CA 94612 Ph:510.874-45001 Fax:510-874-4507 <br /> Job Number: Analysis Requested ° <br /> Project ManageriContact: n t� fir ` <br /> Samplers: <br /> Recorder(Signature Required): _ Na.Containers a <br /> Matrix &Preservative ii� u <br /> Field Sample <br /> ctl U <br /> Identification No. Date Time Lab Sample No. A x Remarks <br /> 'j X <br /> _r.' ►Q1--k'VW3"l '4 4 {•Y ��36 fAt54 'Y1 Cts S'i\.fl ' <br /> i\,g iu-'t31 <br /> J2- <br /> ls3 : buy <br /> 1513L: • N.03- II k <br /> T.- E± <br /> Relin wished b :(Signature) Date Time Receiv d by:(Sig re) Dale <br /> Time <br /> Relinquished by:(Signature) Date Time Received by: Sig t re) Dat <br /> Time <br /> Relinquished by:(Signature) Date Time Received by Lab:(Signature) Date <br /> Time <br /> Sent to Laboratory{Name): �v ,�� 5 rt <br /> Laboratory Comments/Notes: Method of Shipment 10Lab courier LFed Ex Airborne ❑UPS <br /> Hand CarriedE]Priva Courier(Co.Name) <br /> v:. ' r-1, `y"' iZ r, — L.lel r.–...� <br /> White Copy-Original Yellow Copy-Laboratory Pink Copy-Field COC Number: 003042 <br />