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CALIFORNIA LABORATORY SERVICES <br />Page 1 of 10 11/07/07 12:29 <br />Weidman -ACTT Inc. Project: PGEEI <br />4011 Power In Road Project Number. 193491 CLS Work Order #: CQK0083 <br />Sacramento, CA 95826 Project Manager. Jawied Anwar COC #: <br />Sample <br />Idenefiratiun <br />Chain of Custody Record <br />Sampled <br />Date: Ii�2lU ? <br />�;D� <br />/n/ I(�lril/1yI, <br />/'(/y <br />Biffinp IrtlormaNan:Paper_ of _I <br />ELECTRICAL TECHNOLOGY <br />1 W V_ <br />111I \\ <br />Company Name: W�L�g n�� _ <br />Company Name: <br />\\ _II <br />10 CYMam-\ ..._ _ <br />P <br />Address: _' <br />Address: <br />iW.N dbr <br />■ Weldmami-ACTI Inc. <br />4011 Fbmoar Inn Rued • Saoramanio, CA <br />• 95a26 USA ity, Slate: _ <br />City State. 7.ip: <br />D... r nma <br />lepho <br />Phone 9164552204 • Fav 91BA550191 Telephone: <br />Telephone: <br />ramp I w <br />C <br />www.xeidmann.acu.com/' <br />FAX: <br />FAX: <br />_ <br />Project Name: Fl?G 5,T- <br />Report Atm: <br />Contact: <br />-} <br />Contact: T. J; P <br />wq � � `� <br />P.O. C: <br />Sample <br />Idenefiratiun <br />DateTime <br />Sampled <br />Sampled <br />Sample <br />Lo atianl <br />position <br />Tests <br />Required <br />p of <br />Lars <br />Sampling <br />Sam <br />Method <br />Remarks (includere <br />m <br />t)pe k appearance) <br />Council <br />Number <br />LUse <br />Only <br />o <br />Check <br />o <br />F <br />P <br />ll0,,`` 11 <br />1 16 `47 % <br />company <br />iW.N dbr <br />Comgeny <br />OAM 1-7 <br />company <br />D... r nma <br />Temp IT) <br />Dere i Time <br />ramp I w <br />D 1 . <br />Temp Cci. <br />5Uti-74o <br />eAfA riI <br />'j('N Minmt <br />Total Number of Containers: <br />senor'°''3 s'a"°""°' ' "w„ <br />aeanquieMd by: <br />ComoonY <br />aMinquNhudby: <br />C <br />Company <br />ryJ� <br />Mdwd by <br />company <br />iW.N dbr <br />Comgeny <br />wd y ° <br />company <br />D... r nma <br />Temp IT) <br />Dere i Time <br />ramp I w <br />D 1 . <br />Temp Cci. <br />Distribution- White. Canary - Laboratory Pink - Originator No,E amvi..+1. a..unnm ao ilny° a.I.,. 0.. ......... d manss omni nr eneon ena n.e moan <br />ACM.SomavCantmkCCRFrm 45 <br />CA DOHS ELAP Accreditation/Registration Number 1233 <br />3249 Fitzgerald Road Rancho Cordova, CA 95742 www.californialab.com 916-638-7301 <br />Fax: 916-6384510 <br />