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Tma"EMio CHAIN OF CUSTODY RECORD Page of <br /> Environmental and GeolechnicalConsultant 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:925-25349801 Fax:925-2534985 <br /> L l 501 14th Street,3rd Floor,Oakland A 94612 Ph.510-874-4500/Fax:510-874.4507 <br /> Site Name; <br /> Job Number: naiysis Requested -': <br /> Project ManagerlContact: <br /> Samplers: <br /> Recorder(Signature Required): a �" <br /> No.Containers <br /> Matrix �Preservative `' <br /> Field Sample , <br /> Identification No. Date Time Lab Sample No. U y �' <br /> t *�'1?5l. , `-! 3 { a Cl `E , in i Remarks <br /> _ <br /> P - (� <br /> f5g — <br /> l<`�y 1 Nw ii 2'Ll: <br /> ------------- <br /> in wished by:(Signature) Date <br /> Time Re ived by:(Sign ture) Date Time <br /> J 2-- <br /> a7� <br /> Relinquished by;(Signature) Date Time Received b Sig tore) Date Time <br /> Relinquished by:(Signature) Date I Time Received by Lab:(Signature) Date Time <br /> Sent to Laboratory(Name): ` (� 1 i-.. *` Method of Shipment Laboourier 0Fed Ex ,❑Airborne [DUPS <br /> Laboratory Comments/Notes: Hand CarriedDPrivate Courier(Co.Mame) <br /> White Capy-Original Yellow Copy-Laboratory Pink Copy-Field COC Number: 003043 <br />