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I <br /> CHAIN OF CUSTODY ECORD NO Page _of <br /> EXXON COMPANY, USA. (Westcoasts <br /> Exxon Engineer !/91LX 5 Phone 1s_ Z+ :?Z +b ANALYSIS REQUEST <br /> (CHECK APPROPRIATE BOX) OTHER <br /> Consultant Co Name TlLI _ Contact - <br /> Address /Gl�� �flf�d _ 4,r9-�� FaxL��C/� - 15 ❑ ❑ ❑ ° CD <br /> RAS # - 0/-3-?L- Facility/State/State ID# N Only) I 5 W m o <br /> ty R Y) ❑ 6 a <br /> n °S LD °AFE #(Terminal On h) Consultant Protect N ❑m W N w <br /> ❑ o¢ <br /> Location 16 05— � <br /> {Slate) 8� {CIty) SjDCr7D <br /> ❑ W g a <br /> G EE ❑ C&M ❑ SDT W o m m �, o m ❑ ❑ a <br /> ' 1 ❑ o o:Consultant Work Release# Z oo a N 'LJz <br /> Sampled By ¢ g W w 0 a w Cn <br /> ~ o m ° <br /> SAMPLE I D DATE TIME COMP GRAB MATRIX OTHER F#�NATNE oz m � m wv 7 aN aa = t <br /> 20 SOILIAIR <br /> I o x m0c, X Nat <br /> -z <br /> 1 <br /> f63 0 <br /> SPECIAL DETECTION LIMITS (Specify) REMARKS rF /►vi/ Jr .P6 60 t,C L r,7' <br /> 24 HR _' 72 HR <br /> 48 HR 96 HR EXXON UST V <br /> 8 Business A -Contact US Prior CONTRACT NO SPECIAL REPORTING REQUIREMENTS (Specify) LAB USE ONLY Lot Sto age Location <br /> to Sending Sample C41483 <br /> Other PDF ❑ CI EDD <br /> aarac Level <br /> Standard C CLP❑ Other❑ FAX ❑ FAX C-O-C W/REPORT WORK ORDER# LAB WORK RELEASE# <br /> inq shBy Sa pie _ Dat Time Received By <br /> fL <br /> CUSTODY Reinred ed Date Time Received By <br /> RECORD V I / I <br /> Relinquished Date Time Received B <br /> Way dl # /,I1 replicat;AW <br /> Original •White Lab's Copy •Green Client Copy •Yell <br /> M rr M r �r M r rw ■r r ow an <br />