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0 Sparger Technology Analytical Laboratory <br /> 3100 FITE CIRCLE, SUITE 1 <br /> SACRAMENTO, CA 95827 SAMPLE # <br /> CHAIN OF CUSTODY RECORD <br /> RELD SECTION -+ , I ��,{ ,/,,N 2 1875 <br /> /8 7 5 <br /> ;DENT NAME AI �'L � AAA EC� PROJECT ADDRESS �{� N, AUM <br /> lk AA ECJ. C <br /> . A <br /> • Svew cny <br /> to <br /> SAMPLED BY C� W I�'�� ; �!✓C CONTAINERS OBTAINED FROM AYLC <br /> Nr IPMNn Orp.r�¢.00n <br /> AESERVATIVE USED T C— STORAGE TEMPERATURE 0 Ambient 4° C 0 -10o C Other <br /> HAZARDOUS @' oN-"HAZARDOUS ESPECIAL HANDUNG INSTRUCTIONS �Q� ��] <br /> FIELD REMARKS � 1 Cnn� 01 lo.�.� 50u, �,�t�-5 A7 ( lJ p l LtI <br /> COLLECTOR DATE COMP GRAB TYPE R&D STATION LOCATION i OF REMARKS <br /> SAMPLE NO. ISN! DATA IOnd.660M.sc1 CONTAINERS OQ <br /> N:01 �- <br /> - ( - SI I of 1 X- 16al :c SC X —7A v <br /> - f- 1n�1 I x vI I � <br /> k I 5o1L I <br /> X x <br /> -S � 1 X 15oiLJ ! ' I 1 <br /> 1 a 23 I y'- <br /> 1 <br /> TW4-2!qV1 Organization Date/Time Recei ed by Orge iiatio DateTme <br /> ..eleased by Organization Date/Time Received by Organization Date/Time <br /> eleased by Organization Date/Time Received by Organization Date/Time <br /> mk-ABORATORY SECTION <br /> kMPERATURE RECEIVED FEDX AIRBILL# HAND DELIVERED <br /> ANALYSIS RECORD <br /> TYPE OF PERFORMED BY DATE OF RECORDED COMMENTS <br /> -NALYSIS (Signed) ANALYSIS (Lab Book No.) <br /> Jhite - Original Yellow - Laboratory Supervisors Copy Pink - Originators Copy <br />