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0 i <br /> CALSCIENCE ENVIRONMENTAL CHAIN OF CUSTODY RECORD <br /> LABORATORIES, INC <br /> KifF Analytical Note � <br /> 7440 LINCOLN WAY Equiva Waste Disposal Form Page 48-28 Analyses Date------.. / ` ---- <br /> GARDEN GROVE, CA 92841-1432 <br /> TEL (714)895-5494 • FAX (714) 894-7501I.RepdemtNo 3 Page _____ --at <br /> LABORATORY CLIENT Ki ff Analytica 1 LI C CLIENT PRO.AECT NAME 1 NUMBER a-e'r9 r- <br /> ADoarss 413r5 <br /> 720 Olive Drive Suite 1) PROJECT CONTACT Joel K,fi ua USE ONLY <br /> CITYl)a,IS STATE LP 95616 Q[L] - <br /> SAMPLERS) (SIGNATURE) COOLER RECEIPT <br /> T(530)297-4800 77A`- <br /> RAx 530 29748(3 &MAIL TEmP AC <br /> EL <br /> TURNAROUND TIME crvic 1 z1bc, REQUESTED ANALYSES <br /> ❑ SAME DAY ❑ 24 HR ❑ 48 HR ❑ 72 HR ❑ 5 DAYS 10 DAYS <br /> SPECIAL REQUIREMENTS(ADDITIONAL COSTS MAY APPLY) S i <br /> ❑RWQCB REPORTING ❑ ARCH IVE SAMPLES UNTIL_1 I W <br /> SPECIAL INSTRUCTIONS J n !` <br /> :. r <br /> SAMPLING <br /> SAMPLE 10 LOCATIONIDESCRiPTIDN Af�lglf .1 %G (7 <br /> OILT GATE ^v •/ <br /> Q to Iia !C TL �" S' X <br /> 1 LL— Lid <br /> Relinquished by SI ature) I Roomed by (Signature) Date Time <br /> I z�y <br /> Relinquished by gnaWO) Reoeived try (Signature) Dato Time <br /> Relinquished by (Signature) ed by (Signature) pate Time <br /> �l - M3 . vI 10 o <br /> DISTRIBUTION VW*With Onai report.Green to File,YGDOW end Pink to QWrL 1 O/Ol 100 Reviaion <br />