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`". EQUIVA S ices LLC Chain Of Custody Record <br /> i <br /> Lab-1- <br /> W,--- Equiva Project Manager to be invoiced. <br /> Ad*. � Karen Petryna 9 8 9 91 6 8 1 DATE - "d <br /> 6 Z o 5 PAGE of <br /> �' `k{OttS�dNa�' rr: <br /> GaMwvr TBTSR <br /> Blaine Tech Services 2494 Fremont Street, Stockton 70607700736 <br /> AUAWSL 9W CEUVE WL[To(ar-wn"ft*w Dedam): ANONL M4. e+r+a. CONMTAM PPZJICT No. <br /> 1680 Ropers Avenue,San Jose,CA 45M <br /> PROAMCO+rAMI -oar�NY Joa Neei 707-p33-2361 sonamae&& arms a-env cam OTS r03Of81•�! <br /> Leon Gearhart <br /> eA►IPLER+ML S)10* <br /> Ta�aNe PAR. saLrL. <br /> 40"73.055 1403-573-T771 Igearhart9bblafnetedh.com �Sor, rfaJlr� f <br /> TL 04ARM NO TIME(8USINES9 DAYSp <br /> ® to DAY5 13S OAYS ❑ 72 HOURS E3 40 HOURS 13z4 HOURS❑ IPSS rrKN 24 HOURS REQUESTED ANALYSIS <br /> ❑ IA-Rymm REPm FORMAT ❑ U5T AGENCY <br /> GaM MTBE CONMMATION H9N4E8r H<cr1FM pe:9OMING ALLz FIELD NOTES <br /> SPECIAL INSTRUCTIONS OR NOTE'S CHECK BOX IF EOO IS NEEDED � m : � COabalnedPmmvs&m <br /> J3 or PID Readings <br /> ye �, or Laboratory Notes <br /> iq a, <br /> G d <br /> • <br /> Field Sample Identification SAMPLINGMATRIK � x w � E � TEIAPEiiArURE ON RECEM c <br /> DATE I TIME i0 O W r <br /> I <br /> S - 1 !Ye x x k bZ <br /> S+ 3 13Y x x X o 3 <br /> S-c. 31 x x X �( v <br /> s+.iR+rao f R�+'+d b7r t�■1 a.rc rnK <br /> t ! Recrr.d hr t l Dow Time: <br /> Q r <br /> i <br /> %mb"MWOP40 is FDS,YdwandPh*%Ge-rt. 10MAMORMwlm <br /> I <br />