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CLS - Labs � � CHAIN OF CUSTODY CLS ID No.; LOG NO. 17963 <br /> REPORT TO: CLIENTJOBNUMBER FIELD CONDITIONS: J <br /> ANALYSIS REQUESTED / r <br /> NAME AND ADDRESS 5_1761 <br /> ��✓�-�/J/�y'�`J_ tan✓ F 6 tw rr` ,� ':� <br /> DESTINATION LABORATORY <br /> CLS (916) 638-7301 l i ,` 1 <br /> PROJECT MANAGER PHONE# <br /> 3249 FITZGERALD RD. mCOMPOSITE: <br /> PROJECT NAME RANCHO CORDOVA,CA. (n 95742 m <br /> saMPLEo BY ❑ OTHER <br /> JOD DESCRIPTION � ..) <br /> m 00 <br /> SITE LOCATION cc TURN AROUND TIME SPECIAL INSTRUCTIONS <br /> �y <br /> DATE TIME SAMPLE CONTAINER o O Q o o <br /> IDENTIFICATION MATRIX NO. TYPE <br /> µ a 0435_ CS19/09 27— -z- <br /> 0 175-0 <br /> 0175-0 eSMIo9H 7%- <br /> /00 <br /> 0 <br /> /000 G'$M /07 S _ ✓ <br /> /c/o <br /> /5DS TCM•W- I - <br /> /2,G-0 -T-c til`ba- y feJp a ,l <br /> L 4/ <br /> INVOICE TO_TF : <br /> PO# <br /> QUOTE# <br /> SUSPECTED CONSTRUENTS /. ..ay SAMPLE RETENTION TIME PRESERVATIVES: � H <br /> 1) CL (4)LD <br /> =CO <br /> RELINQUISHED BY(SIGN) tt'C�PRINT NAME/COMPANY DATE/TIME RECEIVED BY(SIGN) PRINT NAME/COMPANY <br /> �• 6'CAQTZEI.iJ `�zv o I )Y 3u ')9 >� G✓ tvr G(3 <br /> eta, j c v to '-c F a Z001 <br /> -- <br /> REC' eBY: DATE/TIME: ,-- CONDITIONS COMMENTS. <br /> . <br /> Av. � I r-, , -/ 1- <br /> SHIPPED BY. X ❑ UPS HER — _ AIR BILL# <br />