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SH �1L C�MPAIIIY ' <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST CHAIoNaO� CUSTODY RECORD <br /> 9-I0t,114- pogo ( of I <br /> Silo Address: 6131 Pacific Ave. , Stockton, CA <br /> 1SllC�: Al�a[ysis Required LAR: 9EQ <br /> CHICK ONE(T)IOX ONLY CT/DT TURN AROUND TIME <br /> Sholl Enginoor: Phone No • (510) cw N(oAlodnp 1�CJ 4411 <br /> Alex Perez 67 --6168 24 hours ❑ <br /> JFax !- 675-6172 * si•lor.#�rpdbn C] 4"1 <br /> ConsullanlZj�larno &Address, 0 49 how. ❑ <br /> 131-dine ecl Sery ces, Inc. �,' $aYclault /pq <br /> 1680 Rogers Ave. , San Jose, CA 95112 w y poral ❑ 4412 <br /> 16 darn ®(Norman <br /> Consulianl Conlacl, w warn# <br /> phone No (408) -- cro#rYyroGpa+ar ❑ 4443 ❑ <br /> Tran Tliie 573-0555 �' ad oI A Rom o#3ys ❑ alh.# <br /> ommonis: Fax ' 3--7771 <br /> F o � <br /> � � � use <br /> n NOTE Nollly tab as <br /> rop ( I O i M,Wale r Rem or Sys ❑ 4163 coon or Possible at <br /> 24/41 hn TAr <br /> Sam "pled by. 1- Vo C ash.# ❑ <br /> MEW g'�� n co °' a UST AGENCY: <br /> printed Name: Q o �; o <br /> Q d rz. Q � w _ � <br /> u u# v ` C O f. 6 on <br /> 5pfllpl@ ID Dalo Sludge soil Walvr Alr NO °I x x �}; -6 a d q MATERIAL SAMPLE <br /> cons ; y° ar �j a V 4 UDESCRIPTION CONDITION/ <br /> COMMENTS <br /> Mw-i -I x <br /> 3 x <br /> � 3 <br /> O�fP 3 x <br />------------ <br /> quls v B (slgnalura), Prin—le —Na m^Q _ <br /> PD(aj1u4 <br /> Re Diva (sJgnoluto) Ptlnled Name, <br /> �--L- �j Dala <br /> ulshod 8y(signalum, Pilnlod Name Rocolvvd(slt7nalure) "O <br /> Prinled!lame <br /> ulshad By( gnalura), Prinlad Namo T1mo <br /> eDalReco Daa leo <br /> vPrlNed Name lmo <br /> Tlma <br /> 6 <br /> r Erna g- <br />