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Rrcai <br /> NG C• AIN OF CUSTODY RECORD <br /> Analytiry Phone (916)362-8947 C.O.C. No. 2 5 0 2 2 <br /> 3050 Fite Circle,#112 Sacramento,CA 95827 FAX 916 362-0947 Pa a—L Of _ STAL Invoice Number <br /> Company Phone /l�v` / -r��j fC7 ANALYSIS REQUEST <br /> Project Manager EGA u&ib a FAX 7/ 5'�q556 REMARKS Sampler's Name <br /> Report Add s Billmg Name&Address <br /> 11 N`. -VLV!> ID -/t--' <br /> 5 -nP4'A1wiv C" (V4 . /'5"?5A� All None Some <br /> Project Name �n rN N ProlecttJob# �,r�n OK OK OK WET STLC <br /> Cooler Temp °C t/ <br /> Project Locabon PO# Sample Condition ✓ TCLP <br /> Ci oN CP H <br /> Preservative TCLP Total <br /> Sampling Container Used Matrix 7 1 TAT <br /> L <br /> CO <br /> ao m r <br /> m o <br /> p d N O N <br /> o o co Z <br /> N y0. <br /> co <br /> L <br /> N <br /> Na O a N m ¢ U = <br /> (aa <br /> OO O m U N W N <br /> m o U o m 0 0 0 $ o o m a sa yyf Y <br /> N OD N Gq Cq �r Q <br /> o m COD _ J~ <br /> 5 b Q 0 a m t� co v i5 m '� Z m <br /> -� cin E E `m z m ( to 0 cc � O c r T <br /> p -� uoi s U a m o ham- H nQ rQi 4 a a a o p1 U ¢ Q `� o <br /> NO SAMPLE ID Date Time m o = z o u5 a o m w w w w w w ° z o m v7 101 0 cc r <br /> 1 Metl—1—C 50ar <br /> 2 /�}iIN- -1� �r►l� 9;,vA <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Relin ed Received ReI tjlshed b R iv b f <br /> Date��J &-i Time !%� Date Time 4 Date Time I <br /> Date +� Time <br /> PLEASE READ REVS SE SIDE FOR TERMS AND CONDITIONS <br />