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CHAIN OF CUSIDY RECORD i <br /> i �b12 $°` • 32 <br /> ERM- est, Inc. <br /> 1777 Botelho Drive, Suite 260 • Walnut Creek, CA • 94596 • (510) 946-0455 • FAX (510) 946-9968 Page I Of .3 <br /> PROJECT# PROJECT NAME MATRIX REQUESTED PARAMETERS <br /> �7 <br /> • <br /> SAMPLER (PRINT NAME) (SIGNATURE) <br /> RECEIVWG LABORAT R <br /> fit G l.-C 4� • � ,�v ;�� �( �, <br /> fj <br /> SAMPLE I D DATE TIME 0 a SAMPLING u)? w SAMPLING <br /> d METHOD a > VOLUME Q <br /> Mid-SAA) IZ 11 1M5 I V- 13 DC DC DL <br /> ,o <br /> MW-3A )zits 6 13 x 9C �e— x oc <br /> RELINQUISHED BY(SIGNATURE) DATE TIME R Y DATE TIME FIELD REMARKS <br /> "ELI Q ISHED lGNATURE) DATE TIME REC BY DATE TIME <br /> -� 2. �q I 1n� t2-I� l <br /> RELINQU {SIGNATURE} DATE TIME RECE ED BY DTE TIME <br /> REMARKS ON SAMPLE RECEIPT ERM REMARKS SEND REPORT TO <br /> ❑ BOTTLE INTACT ❑ CUSTODY SEALS ❑ CHILLED <br /> 0 PRESERVED ❑ SEALS INTACT ❑ SEE REMARKS <br />