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i <br /> �SSkQC: FATE <br /> CcrtificLi L .,'bnmental&rviecs Central <br /> L 1885 N.KELLY ROAD NAPA,CA 94558 • {767}257.7211 • Fax{707}22G•iODY Coast <br /> Air,Water,&Hazardous Waste Sampling,Analysis,&Consultation A�alylacal <br /> 4' Stale Cerlilied Hazardous Waste.Chemistry,&Bacteriology Laboratories Scrnces <br /> ��'-e SAMPLE CHAIN�OFUSTODY <br /> SUBMITTED BY: <br /> COMPANY <br /> 1lI vws Gf}S.SOC,*672S CONTACT NAME �/ <br /> ADDRESS ra a C G PA114 LL /KFFTvNs <br /> 2bso 'l`i re GIv _'hc"A7 Yrro PHONE <br /> yy6 �6y s3id J <br /> PROJECT t1 PROJECT NAME ANALYSIS REQUESTED °- <br /> �a�9a-vara /f7oDne" <br /> PeT r tt�i $sc.`r;rc' f1 vc" III PIN14CA 1 ..A �, a <br /> SAMPLER IPrinl d Sign Namol ��t" [L m <br /> Dn4Rrr— --- -- � r <br /> 7 W U <br /> SAMPLE DENTIFICATION OATEITiME rt oI PRESERVE l� m IL <br /> g <br /> {ID q,IocaGon,matrix) COLLECTED ITEMS r(?tir < <br /> r REMARKS <br /> ! M+✓^j A lo.o-,Is YT 6 �! gp e <br /> 1 No <br /> ��� rrtt+.�1.4 ,s•o�1G.S fT <br /> i <br /> f <br /> �p rtv�lr. <br /> 1_9/'7_ <br /> 111`7i <br /> SAMPLE RELINOUISHED BY: DATErTIME RECEIVED BY. �— <br /> �x� 90 0OC9 <br /> Vis 4. <br /> -S � 4-0 �. <br /> r <br /> i <br /> i . <br /> i <br /> i <br /> i <br />