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Analytical ChemTech <br />AO International, Inc. <br />4011 Power Inn Rd. <br />Sacramento, CA 95826 <br />Phone: (916) 455-2284 <br />FAX: (916)455-0191 <br />Project Name: <br />Project N: <br />Contact: <br />Chain of i ,ody Record <br />Company Name: v� 1 <br />Address: yU vC) l!/fJT ,; <br />City, State, zip: C.4 9.x761 <br />Telephone: 70 9 9 y/Z —/�// 5J <br />FAX: l ae 1 9iQ - /.s� 7 <br />Report Attn: '';Al; <br />* PCB Wipes must include surface area sampled (cm') <br />Page: _1_ of <br />Billing Information: <br />Company Name: <br />Address: (% o i 3C) <br />City, State, Zip: <br />r <br />Telephone: .SA`/E i <br />FAX: S� �`— <br />Contact:��` <br />P.O. k: <br />Relinquished by: <br />Company <br />Relinquished by: <br />Sample <br />Relinquished by: <br />company- <br />Control <br />Check <br />Sample <br />Date <br />Time <br />Location I <br />Tests <br />k of <br />Sampling <br />Remarks (include <br />Number <br />one <br />Identification <br />Sampled <br />Sampled <br />Position <br />Required <br />Jars <br />Method <br />type & appearance) <br />Lab Use <br />Only <br />F P <br />0DS <br />P6S 7 ---ea <br />41 <br />555 <br />1Z C <br />2'N/� oLXI <br />/'<'z3 <br />� <br />4��- <br />�/ <br />asT 3 <br />d z 4.' <br />1600 <br />& / Pe t e <br />guy <br />r^13 <br />OSi Sl <br />/z 9d <br />G <br />L ��f PoLE <br />ff <br />PasT .•S <br />is 9 <br />/G/5 <br />J/ Y �✓ <br />pat., <br />z <br />Total Number of Containers: <br />5 <br />samplers Signature! / F: Entered <br />7 <br />Pr Prmervetl <br />Relinquished by: <br />Company <br />Relinquished by: <br />Company .. <br />Relinquished by: <br />company- <br />Received by: <br />Company <br />Received by: <br />Company <br />Recel d by L b` <br />Company <br />Date / Tim <br />Temp I' 1 <br />Date / Time �� <br />Temp PCI <br />Date / rite" <br />Temp ('CI <br />nictrih,,tinn- whit. ('anary - I Pin L- - —1— e.......ie. ..._ a:____._. — _..__ -- ___ --_ I _._ __I_ <br />