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Tfea"UN10 CHAIN OF CUSTODY RECORD Page of- <br /> Environmental and Geotechnical Consultant KR 555 Montgomery Street,Suite 1300,San Franctsco,CA 94111 Ph 415-955.90401 Fax 415.955-9041 <br /> 2 Theatre Square,Suite 216,Orinda CA 94563 Ph 925-253.4980 l Fax 925-253.4985 <br /> 501 14th Street,3rd Floor,Oakland,CA 94512 Ph 510-874500 I Fax 510$74.4507 <br /> Site Name <br /> Job Number 3 , (O Analysis Requested. IIWPI, <br /> Project ManagerlCoct I)C ow) <br /> Samplers <br /> Recorder(Signature Required) No Containers <br /> Le aC <br /> Matrix &Preservative I <br /> ~� � r <br /> 11 WO <br /> Field Sample b <br /> Identification No Date Time Lab Sample No U <br /> &14 <br /> y = ' t� Reiriarks <br /> �3 o 0 <br /> r -max-5 <br /> ro <br /> %-oJ6- f <br /> l <br /> elih ish d b (Si nature) Dale Time Re rued by gnature) Date Time <br /> f i Do? 6• • o <br /> Reiv ed y (Signature) Date Time ived by ignature) Date Time <br /> Relinquished by (Signature) Dale Time Received by Lab (Signature) Date Time <br /> Sent to Laboratory(Name) _ Method of Shipment []Lab courier Ded Ex ElAirbome E]IJPS <br /> Laboratory Comments/Notes Hand Camed❑Private Couner(Co Name) <br /> white Capy-Original C Orr Yellow 0033 1 3 <br /> g py-Laboratory Punk Copy-Field COC Number' <br /> Om 0 Co d MOW nice <br />