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L-4k6 94 V- V- SHJLL Chain Of Custody Record <br /> Lab Idenhfi-*essary) Equlva Protect Manager to be Invoiced i st vso v) <br /> Address <br /> segxc�aeNG>N Karen Petryna 91 8 91 9 61 11 8 1 9 DATE <br /> Gh Slate Zip ❑TMMC L SERVM SAX OW*0El {�L if+l fi PAGE �� of <br /> ❑ow fflu DN� 1 —7 Z <br /> SAMPLING COMPANY LOG CODE SITE ADDRESS{Stud and GIM OLOWL IO NO <br /> Blaine Tech Sernces aTSR 6131 Pacific Ave. Stockton T0607700380 <br /> ADORES& EOF DELIVERABLE TO[PAvwmW-P"or Dmw, r PHONE NO EJAAL CONSULTANT PROJECT NO <br /> 1680 Rogers Avenue,San Jose,CA 95112 a36ar-% <br /> PROJECT coNTACT[Nrticaor v FOF wpa�bk Aub Cool 707 935-238$ sonomaedf cambrl"nv com STS e <br /> Leon Gearhart <br /> sAAPLER NAAE[ay(F1.�rt E.A;B i18B'tIEE.Y <br /> TELEPHONE FAX EWAIL <br /> 408-573!:g555 408-573-7771 laearharl blainetech eom 1 ���..!` •� ""'""' <br /> TU ROUNDTIME(BUSINESS DAYS) <br /> 10 DAYS ❑ 5 DAYS❑ 72 HOURS[1 48 HOURS El 24 HOURS LEM THAN 24 HOURS <br /> REQUESTED ANALYSIS <br /> ❑ LA 0QU REPORT FORMAT ❑ U5T AGENCY, <br /> GCIMS MTBE CONFIRMATION HIGHEST HIGHEST per BORING ALL FIELD NOTES <br /> 0 <br /> SPECIAL INSTRUCTIONS OR NOTES CHECK BOX IF EDD IS li9I NEEDED LJ <br /> m ContalnerfPreservative <br /> J p <br /> � � $ 3 or PID Readings <br /> a a 8 ff or Laboratory Notes <br /> CL <br /> �o s, _ �aErS <br /> iP Y7 �i [n lii <br /> v m O <br /> 6 p N N �^ d <br /> l7 z p c Q Y Q <br /> Usp <br /> Field Sample Identification SAMPLING MAfRUtNO OFCONT w w m 'K' fig a s TEMPERATURE ON RECEIPT C' <br /> LIlM1Y DATE TIME F O 7r r w <br /> 3 G <br /> ti Mw"3 PIED <br /> rnw— Ww <br /> w—s 0M o <br /> U <br /> 07 <br /> x <br /> n <br /> 0 <br /> 1z33 3 X 10 <br /> v G <br /> R t y I. Rectivcd bf[Slarmerci Date Time <br /> s ------------ <br /> Re6nouis}w!d4y (Sg'A.) fft2M <br /> Date Time. <br /> DISTRIBUTION W hde.0 fin9 report,Green to Pik Y A.and Pirie b Ck . LA1Q'18�00 Revision <br />