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CHAIN OF CUSTODY <br /> -mala-hem ndcA,.,PBErL ,a.� -r+tc. . -ter - :, 9x <br /> say w.-U-b � R,,..m-a.4ir65- 2s2-92L 2 REPORTING REQUIREMENTS BELOW: <br /> EflYIFBMv a tat'bebs Pi a-+-R4 Lb. 945(.5 P _ <br /> Project Manager: l - Phone#: ALM_ PDF/Standard Format <br /> Email Address for Reporting: ;L.�afly✓I. C32E[L�T�1/+cc..d, e,7cell#SXj Geotracker/EDF/Provide Global ID <br /> Email Address for Reporting: <br /> Company Name 8 Address:7 �GO P.O#/Project Name: EDD/Equis/Data Table <br /> lAr, //Y,f Sfpl MDL Formal <br /> �m ✓.Lf� &49'f/.DS roleG Lomlbn: /{+6 <br /> Billing Address: o Data to be reported to Slate's Database?Yes_No_ <br /> !Z v?-7,5�l Sampler EDT I CDPH-Provide Source Codes/PWS ID: <br /> N"'^-BG-e Sampler Signatur page of <br /> ANALYSIS REQUST LAB USE: <br /> Matrix Table: Preserved?(Mark res a^ if both a+aiublo) Melals Bin#: <br /> S=Soil/Sludge I Solid(circle one) Yes Snc Total <br /> A=Air m No <br /> F <br /> DW=Drinking Water x_ <br /> MW=Monitoring Wells m m m E N <br /> GW=Groundwater y E a =- a`t U ¢ 00 <br /> TW=Treated Water m 1'_ H �, m n a a s k Microbiologyu) N a m n E m m E E <br /> WW=Waste Water -- � Enn_ o ¢ » ¢ ¢ � w <br /> zic <br /> S.. I SAMPLING 7772'5 0 E E o m E E o E = Work Order. <br /> SAMPLE ID: code. DATE TIME # F U N a a r v m <br /> L14-1 12h5 5 <br /> ZjtL z 2//5 oRsv <br /> /9-3 1.2115 0 <br /> 9 5 <br /> UL-5 5 5 <br /> //-(, -i- A V/,,DATE <br /> L Ff-} 7 40 <br /> LH--e Z2 S 5D <br /> IS 215Reli wishedq� TIME Recei Remarks: <br /> -2 945f <br /> 15 <br /> Relinquished by: TIME Rec oratory: <br /> agO 41 01 <br />