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0 <br /> *ate f'� �r Weather a Z Of i <br /> ERM=West Chain of Custody Record <br /> 2001 "P° Street, St.ilte 200 " Sacramento, CA • MM • (916)444-9378 <br /> Job# 19'70 oy,Q2 Collection lrtrxy Other Remarks <br /> Jab Location L p <br /> IT Sampler(signature) .�iu � a!: y I ! � I � +� � �� a � ! E <br />°' o, ! E <br /> Printed name L",e <br /> Lab Report Reciplenf ! 5 I i Q! i E o! a I I I E <br /> + Tel No_ ID <br /> ° i �� ! ! ! •� <br /> ! N o al i I E O <br /> Receiving I eb A <br /> n l £ , i =� i <br /> N m <br /> Address m I l E m ail . i al I d, a �; I <br /> l rOwarter C=comp U. a c�! a ' E f Z <br /> Sample ID# Time 3-soli asn oli�rrle —: <br /> I1_-_ ) - /700 <br /> S <br /> �----i ___.i,_ F ! <br /> 11 _ W-7 <br /> —ri - <br /> �' <br /> LLtl <br /> Precautions Conc: 0 LoD Med 0 Hi Ship Via Total Number of Coritalrrers <br /> m -77 Sample Relinquished By Date Time Received By Date Time Reason for Transfer(List Shipping mill Number) <br /> �bom�ml <br /> enn[wrW <br /> 'E LABORATORY Samples s S o containers O er fags se <br /> 0 �Ffease Com-Plete Intact EJ at 4°C _ not leaking — matches C_ot-C — — – match C-01-C — _ Ntad — _ — — — — _ ! <br /> Lab Semple custodian Stgnature— — Date— — r Trm$ TSample Disposition 0 Return to Ske !3 t3lseard n Hold days <br /> L - - - ---- -- - 1 / �o�aazi�ro y <br /> -f � 4 Lal,% r d R 1 . A l S ur r <br />