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113S <br /> Trw"Emlo CHAI F CUSTODY RECORD Page!of <br /> Envrronmental and Geotechnical Consultant 555 Montgomery Street,Suite 1300,San Francisco,CA 94111 Ph 415-95"040 9040 1 Fax 415-955-9041 <br /> 2 Theatre Square,Suite 216,Orinda CA 94563 Ph 925-253-49801 Fax 925-253-4985 <br /> 501 14th Street,3rd Floor,Oakland,CA 94612 Ph 510-874-4500!Fax 510-874-4507 <br /> Site Name �� — <br /> Job Number D Analysis¢Requeste- <br /> Project ManagerlCo f <br /> Samplers <br /> QL <br /> Recorder(Signature Required) NpContainers �. <br /> Matrix 9&Preservative <br /> ra� 'Lr? .."r.��'i�Y%^"37s,`� ; -s�g 'f'a�+ .+- <br /> Field Sample � � ' ��'` " a �' io v C C °; � W <br /> Identification No Date x Time ➢ L b'Sam le No <br /> psa <br /> y x �� Remarks <br /> a/ t 3 <br /> c5 - --2�7- 2, 11 40 <br /> C 5 3-3- _e, zZl� <br /> Relir, w <br /> Wdby J, ,Aat r ate Time Rececv d by (Signature) Date Time <br /> Relin hed by (Signa re Date Time Received by (Signature) Dald Time <br /> f 7.D d <br /> Relinquished by (Signature) D to Time Received by Lab (Signature) Date Time <br /> —2-o <br /> Sent to Laboratory(Name) Method of Shlpment Lab couner 0Fed Ex F�Aubome FJUPS <br /> Laboratory Comments/Notes E]HandCamed❑PnvateCouner(Co Name) <br /> White Copy-Original Yellow Copy-Laboratory Pink Copy-Field COC Number 002801 <br /> Mlop ♦ � <br />