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LAB -K, (- C — S L Chain Of Custody Record 2SZZ <br /> An <br /> Lab Idenbfica0-Y) Equiva Project Manager to be Invoiced Iwo WWVl O MFOKV� <br /> Address <br /> El �+ <br /> � C#�� �+ Karen Petryna 9 8 9 9 6 1 8 9 oaTE 3 " 1-O 3 <br /> Clly State LP [�'tECHWC tL SEFIV M a PreA WtWR i I Am r) r <br /> ❑GRMI #SPION PAGE �_ of f <br /> 54A PLINo COWANv LOG CODE VM ADORESS(street and Ity) OLO9AL 10 NO <br /> Blaine Tech Services STSR 6131 Pacific Ave Stockton T0607700380 <br /> ADDRESS EDF DELNFAA9LE TO 0%Rspom6N PWV a OWgr r PIgNE NO EWL CON511LT.Wf PROJECT NO <br /> 1680 Rogers Avenue,San Jose,CA 95112 10.3 p 131 _TQ <br /> PROJECT CONTACT INrAwpy a POF a.pn„ar AubreyCool 70 933-2368 sonomae camtuia-env corn ars/ <br /> EJ1kIPL.EA lvAkEI61[Ftfnit <br /> Leon Gearhart E0 V9Eph�.Y <br /> TELEPHONE FAX E-"L <br /> 408-573-OSS5 408-573-7771 Igearhaltc0blalnetechcom �dovl (]/01..1 t� <br /> TURNAROUND TIME(BUSINESS DAYS) <br /> t, 10 DAYS ❑ 5 DAYS❑ 72 HOURS❑ 48 HOURS ❑ 24 HOURS❑ LE55 THAN 24 HOURS REQUESTED ANALYSIS <br /> ❑ LA RWQCB REPORT FORMAT ❑ UST AGENCY E <br /> GCNS MTBE CONFIRMATION HIGHEST HIGHEST per BORING ALL MELD NOTES <br /> SPECIAL INSTRUCTIONS OR NOTES CHECK BOX IF Epp IS Wa NEEDED LJCorttalnarlPreservative <br /> m <br /> or PID Readings <br /> n ,a aor Laboratory Notes <br /> rc <br /> w o <br /> m pm w <br /> IL m m N N m O <br /> c n m a <br /> LAAx W C t TEMPERATURE ON RECEIPT G' <br /> = m <br /> SAMPLING Na OF w n _ <br /> US9 Field Sample Identification MATRIXCONT <br /> dNLV DATE TIME m O W rE r 1u <br /> N <br /> A <br /> Qf <br /> ReW as I e1 Recnved by �e <br /> DSgaa ) Dale Time <br /> a_ <br /> C <br /> Re6qu tsvnenre) Received by(Sgna4Ne) Dela; Tine u <br /> t <br /> Rebmu wl Sgnaera) Received by(Sgnahre) • Date: Time <br /> Ore <br /> DISTRIBUTION W telesvdb final reWrt,Grem b I de Yeeow and Pink b Ckm1 10f15w Rev,sion <br />