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�r rr r rr r� ■r r� r r� r r r r r r err �■r �r r� <br /> rea" b CHAIN OF CUSTODY RECO D Page to, <br /> Environmental and Geotechnicat ConsultantP501 <br /> 55 Montgomery Street,Suite 1300,San Francisco,C 94111 Ph 415.955.90401 Fax 415-955-9041 <br /> Theatre Square,Suite 216,Orinda CA 94563 Ph 9 253-4980/Fax 925-253.4985 <br /> 14th Street,3rd Floor,Oakland,CA 94612 Ph 510-074,45001 Fax 510474.4507 <br /> Site Name r k�a.k� `stn C3� <br /> Job Numbervs1 0 l clysis Requested <br /> Project ManagerlContact ar,n ;mAS o u' <br /> Samplers Q- u' rs <br /> Recorder(Signature Required) No.Containers a6 <br /> Matrix &Preservative O ' i <br /> �^.-'S `moi' m p <br /> ,'"*'tr'3� �:` ''*a4 N N D1 �' Y <br /> Field Sampled w'ra 9 a a m r �I <br /> Identification No ""Date,: -Time = Lab Sample No in = t. Remarks r' <br /> 01)?31 XXX <br /> � X <br /> X l x X X <br /> -7 T -c,G-ib Soo X <br /> s x <br /> I S Received °t ct <br /> 4 <br /> I—tU <br /> hnquished by,4,1 ture Date Time Received by ( ignature) Date Time <br /> i <br /> JlReh shed by (Signature) Dale Time ignature Date Time <br /> Relinquished by (Signature) Date Time Received by Lab (Signature) Date Time <br /> Sent to Laboratory(Name) Method of Shipment 01-ab couner Ded Ex DAubome DuPS <br /> Laboratory Comments/Notes Hand Camed❑Pnvate Courier(Co Name) <br /> White Copy-Original Yellow Copy-Laboratory Pink Copy-Field COC Number 002880 <br />