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EQUIVA Se es LLC Chain Of Custody Record <br /> Lab IdenhEquiva Protect Manager to be invoiced INCIDENT NUMBER(S&E ONLY) <br /> Adclroas <br /> M9CJENC€&ENG1WERI Karen Petryna 611 -31 91 61 1 8 s DATE Ea - O] <br /> City State Lip •- --�--�NN ------ <br /> ]TECUL SER1110ES SAP ar RMT NUMBER(TSlCRMT) <br /> (]CRWi1QJSTON PAGE �^ of <br /> CONSULTANT COMPANY SITE ADDRESS(Slreal and City) <br /> Blaine Tech Services <br /> ADDRESS 6131 Pacific Avenue, Stockton <br /> 1680 Rogers Avenue PROJECT CONTACT(Rp dm) CON81JLTANTPROJECT114 <br /> CITY Nick Sudano <br /> S <br /> San Jose,CA 95112 SAMPLER NAME(S)(Pnm) LA 19 USE ONLY <br /> TELEPHONE J0-8 MAIL � rA <br /> 408 573-0555 40$S73 1771 In:udano4lblainatech com r"' Ve I(TURHAROUND TIME(BUSINESS DAYS) <br /> QFIO DA)5 ❑5 DAYS ❑72 HOURS []18 HOURS ❑24 HOURS Q LESS THAN 24 HOURS EQ,U ESTED ANALYSIS <br /> ❑I KW4CB REPORT FORMAT ❑UST AGENCY _ <br /> — E 8 <br /> GL,JrdS Ah i FJL C0I1 FIRJv4ATIOrJ HIGIJEST HI(AiEST pe(SORING ALL E o Z FIELD NOTES <br /> '''"'���^^^TTT���^^TTT a <br /> SPECIAL INSTRUCTIONS OR NOTES aEMPERATURE ON RECEIPT C' o <br /> 0 m c e G Container/Preservative <br /> c a° or PID Readings <br /> a co € or Laboratory Notes <br /> m x <br /> U1 r, U <br /> N a N v m <br /> M O 1V S <br /> O <br /> AE µ Field Sample Identification SAMPLING MATRIX CO of d � f ~ d x <br /> I) DATE TIME CONT i- m 2 2 H O w <br /> _ M," I -!c. C, 3 <br /> --mss S X <br /> Ll F_ <br /> _ Lb <br /> Q <br /> Rew xTa,hcd Gy(Sigalu•cl Racehred by(slpnawre) Pale hma r° <br /> kcMnyr hedll I_ ue — <br /> �Rciollllfql D91 ITime u <br /> ReYn rsnad Gy(k9naiucl ecelve (Nifnaiue) Ople Time p <br /> W <br /> O <br /> 011 TRILIMIUll Mile wiihfine]reloil:G14enloF114 YclowandPialoCilenr 1wI610URevision <br />