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i i I �ST4 <br /> Tma"Eftio CHAIN OF CUSTODY RECORD <br /> Environmental and Geotechnical Consultant Page�Uf <br /> 555 Montgomery Street,Suite 1300,San Francisco,CA 94111 Ph 415.955-90401 Fax 415-955-9041 <br /> 2 Theatre Square,Suite 21EOrinda CA 94 h 925-25349801 Fax 925.2534985 <br /> CA 946 P <br /> 01 14th Street,3rd Floortaakland, h 510-8744500/Fax Fax 510-8744507 <br /> Site Name ���` � i <br /> Job Number Anal <br /> !Jested .{ <br /> Project ManagerlCantact � � <br /> Samplers t C <br /> Recorder(Signature Req d) No.Containers <br /> CL <br /> IL <br /> Matrix &Preservative t <br /> Y Jt ��°;titx�J�# �''� Y� 4 <br /> Field Sample % , °`Y _�% �' d ) <br /> . m <br /> Identification No bata/n� Time Lab Sample No o .. "' p _ <br /> N = a } Rentarlts <br /> 5-ftx A 0�d <br /> tet)? � � <br /> G <br /> -------------------- <br /> ---------------- <br /> inqu h y ignatur palet `y` Tim Re rc by (Signature) Date <br /> LV— q Time <br /> q h d by (Signature) Date O -II –01/ l 2' <br /> Time Received by (Signature) Daie Time <br /> Relinquished by {Signature) Date Time <br /> Received by Lab (Signature) Date Time <br /> Sent to Laboratory(Name) Method of Shipment Lab couner E]Fed Ex Airborne UPS <br /> Laboratory CommentslNotes Hand Camed❑Private Couner(Co Name) <br /> 1:1White Copy-Original Yellow Copy-Laboratory Pink Copy-Field COC Number 003315 <br />