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1 <br />Chain <br />of'(3.. Jody Record <br />Dat ,? /3%s�7 <br />A� Analytical ChemTech <br />Page:_L of <br />International, Inc. <br />Billing Information: <br />Company Name: <br />D L <br />Company Name: <br />� <br />Power Inn Rd. <br />Sacramento, <br />Sacramento, CA 95826 <br />Address: <br />yvf/p /tiff% c//M/E <br />Address: <br />PO- RO 1 090 <br />City, State, Zip: <br />silt We *Al N C/j 9.20 V <br />City, State, Zip: <br />57-0CX70/E�� �%fZo <br />Phone: (916) 455-2284 <br />' <br />Telephone: <br />�lcri �1 /f�/S <br />Telephone: <br />51"16 't) <br />FAX: (916) 455-0191 <br />FAX: <br />7U49V,?- /So7 <br />FAX: <br />51411yE <br />_ <br />Project Name: �C <br />Report Attn: <br />EO�/E Lia C�/S <br />Contact: <br />Si /L',C55 <br />Project b: <br />Contact: <br />• PCB Wipes must include surface area sampled (emu) a P.O. N: <br />Sample <br />Control <br />Check <br />Sample <br />Date <br />Time <br />Location/ <br />Tests <br />N 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 FP <br />�d/PE syZ �osl'~ <br />/So 7_ <br />/,d/�E <br />e�S se c 410 <br />/Ns t7P <br />oE•K�/ <br />S a <br />d/rte <br />a� sa of -,� <br />Total Number of Containers: <br />/ <br />Sampler's Signature: <br />F: Ffft.redW <br />P: Preaane <br />Relinquished by: <br />Company <br />Relinquished by: <br />Company-` <br />Relinquished by: <br />Company <br />Received by: <br />Company <br />Received by: <br />i <br />Company <br />ReceiVivv� by Lab: <br />Company <br />Date I Time <br />Temp ('Cl <br />Date ! Time j <br />Temp ('Cl <br />Date I Tim <br />Temp I'CI <br />