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AEMC Job # '•=, r� (CONFIDENTIAL) AZIMC Log # <br /> • e:*�•:**• SAMPLE MANAGEMENT RECORD •**re*:**• , <br /> Generator/Client `_'? L.. C. '(.-) .y 'C _ O <br /> AEMC Project Manager .T tv1 ��� 11 t <br /> Job Description LT ( � <br /> SAMPLING INFORMATION ` J <br /> A Sampling Date i i-7 - c n Sampling Collector ���1� 1 ;% 4 fu <br /> • Sampling Location <br /> (Provide sketch on back and match sample # with sampling location) <br /> Suspected Toxic Constituents <br /> F <br /> Field Conditions ,(" . J\ W )�Z b'\ <br /> • Sample Depthl Time Sampling U <br /> Sample # Type Drum# Sampled Method Notes <br /> 'I <br /> • 1-�-«%-z� 1( 11 <br /> (For more than 4 samples, attach a Continuation Sheet) <br /> • LABORATORY ANALYSIS <br /> Laboratory �1'� Contract/Phone # <br /> Date/Time Samples Delivered AEMC P.O.# <br /> • Report Due Date "Rush' Authorized by <br /> Analysis Requested 6L r rc; r <br /> • Send results to AEMC Engineering Division, Attention: <br /> Sample Retention Instructions �� c <br /> CHAIN OF CUSTODY <br /> • <br /> Relinquished by (Company) Received by (Company) Date/Time <br /> AMERICAN ENVIRONMENTAL MANAGEMENT CORPORATION <br /> 11855 White Rock Road, Rancho Cordova , CA 95670 (916) 925-6666 <br />