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CALSCIENCE ENVIRONMENTAL CHAIN OF CUSTODY RECORD <br /> LABORATORIES, INC <br /> Kd(Anal tical Note <br /> 7440 LINCOLN WAY y ( � jj I� <br /> GARDEN GROVE, CA 92841-1432 Equlva Waste Disposal Forrn page 48-28 AroatySes Date <br /> TEL (714) 895-5494 a FAX (714) 894 7501 5Id 1�2 5 3 Page of <br /> LABORATORY CLIENT Klff Anah tical L LC CLIENT PROJECT NAME IN UMBER N r <br /> ADDRESS IlHo ' + C k e'r4e,' blJ`lYl_S c k+7� <br /> 720 Olive Drr�e Suite D PROJECT CONTACT Joel K1ff LAIII USE ONLY <br /> CITY Davis STATE CA ZIP 95616 D a -010 <br /> SAMPLER(S) (SIGNATURE) COOLER RECEIPT <br /> �Sit)1297-4$G(1 530 297-4$03 <br /> EMAIL <br /> °C <br /> TURNAROUND TIME IOtitp. mc- REQUESTED REQUESTED ANALYSES <br /> ❑ SAME DAY ❑ 24 HR ❑ 48 HR ❑ 72 HR ❑ 5 DAYS ❑ 10 DAYS --- cL <br /> SPECIAL REQUIREMENTS(ADDITIONAL COSTS MAY APPLY) _ } <br /> ❑RWQCB REPORTING ❑ ARCHIVE SAMPLES UNTIL--/ --- I <br /> SPECIAL INSTRUCTIONS -r .f3 <br /> I <br /> U <br /> v 7 Y+ G WLM 4 <br /> C` v <br /> SAMPLING <br /> �i <br /> SAMPLEID LOCiT10NIDESCR{PTIDN � TIME rwrna tort F r-0 T�, <br /> t tr <br /> Z S `I )I I SZi 1 ) X xG <br /> Relinquished by (Signature)� Received by (Signature) pate Time <br /> Relinquished by ( nature) �T Received by (Signature) Date Time <br /> Relinquished by (Signature) R rveVfarlLaboratory by (Signature) Date Time <br /> DISTRIBUTION While moth final report Green to File Yellow and Pink to Client 10101100 ReviaiDn <br />