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CALIFORNIA LABORATORY SERVICES <br />gage 1 of 10 11/07/07 12:29 <br />Weidmann-ACTI Inc. Project: PGEEI <br />4011 Power Inn Road Project Number. 193491 CLS Work Order #: CQK0083 <br />Sacramento, CA 95826 Project Manager. Jawied Anwar COC #: <br />' ■ �iD� Chain of Custody Record <br />Date: I I I2IU'1_ <br />■W. E /ry �60 � <br />Page: I of I <br />N11inp Inlormation:'� <br />TECHNOLOGY (� �f1II l\ ,yI'^'' /� <br />l\ <br />ELECTRICAL Canpany Name: thJQl�Yv yA(�` 1 <br />Company Names <br />Address: r <br />Address: <br />■ well M.n Aert me. <br />4011 Power Inn R, • Sacramenw, CA • 95926 USA try, Stale, Zip: _., _ <br />City, stale, Zip: _ <br />Fax 9169550191 Telephone:Telephone: <br />Company <br />Phone 9164552264 <br />waw weklmann.ac6.oan CFAX: <br />_ <br />FAX: <br />Project Name: i 67G ai: Report Atm: <br />Contact: <br />Project d: 113Y9 I 15 <br />r <br />P.O. M: <br />Contact: ? r.1; 11 Un <br />Temp M <br />Oeu I m. <br />Temp rC, p <br />Sample <br />�Ir= <br />Control <br />Sample <br />Date <br />Time <br />Lamliunl <br />Tests <br />#of <br />R <br />Number <br />4FP] <br />Iskmdnuuon <br />Sampled <br />Sampled <br />Position <br />Required <br />Tan <br />,,k,(include <br />lYpe 1� apprarance) <br />Lob Use <br />Only <br />D <br />Total Number of Containers: I Gj I S." I r" s'o""0101 , ,,;,,„b li <br />Ulr,.46ed by <br />comp..' <br />nNirqubbid bY: <br />Comperry <br />9IIr9 Nd eY <br />Company <br />INc.wd by <br />Company <br />aewived by <br />Compere <br />yed <br />Compere <br />Otle I Tlm. <br />Temp 1'CI <br />Cere! Time <br />Temp M <br />Oeu I m. <br />Temp rC, p <br />/Distribution: White, Canary - Laboratory "nh OYlob.am, nut.. s....... <m.."m=p au den .Imr •anon, xm..m••:m umre. mra• e•r.npume.n .r. m.ae <br />A° C.ermp..Co.eo1.CCR.R .405 <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 />