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I <br /> A► N 4 N iW CHAIN OF CUSTODY RECORD <br /> Analytical Laboratory Phone (916)362 8947 C.O.C. NO. lJ <br /> 3050 Fite Circle #112 Sacramento CA 95827 FAX (916)362-0947 Page�_ of STAL Invoice Number <br /> Company -`-r 6v.P Phone 9 7-C 3 ANALYSIS REQUEST <br /> ProlectManager pe y.qa� e- FAX 3�I 3�`f REMARKS Sampler's Name <br /> Report Address Billing Name&Address <br /> 36 SIC 0e, s <br /> CA I`ib S� Ma 0,e� c,0 g 4�--6 3-3 All None Some <br /> Protect Name 5&, Alt/,ly ProlecUJob# ';76 3 2-11 OK OK OK INET STLC <br /> I Cooker Temp °C <br /> Protect Location S s ac [c /w" PO# Sample Condition TCLP <br /> H <br /> Preservative TCLP Tota! <br /> Sampling Container Used Matrix TAT <br /> �i <br /> O N <br /> co r <br /> in in r N Iv <br /> CD <br /> F) 2 +1 Z N <br /> 0 Y N V <br /> ` o o civ a r <br /> m N .�'�. c rc <br /> N <br /> A o `° F Ln a LO L0 co U �? C c <br /> U w ON d N W d .X <br /> N m U' O O co O N N O (0C', U <br /> yc m ar 4 O co " <br /> a- <br /> 0 <br /> a co W v in °a m -� v as <br /> [9`l 7 Q z d o o Q Q o m ui <br /> EN � E w = w w _ cn co m cb O a a ro z <br /> O J in � U O L O t 1- H Q. d d d d d a O a' U Q Q cd m 7 O <br /> NO SAMPLE ID Date Time m cv 4 z z u) ¢ o m w w w w w w ° z o M 0 0 in cr I _ <br /> 10 2- ILI ✓W I ! v <br /> S32 10 Z Y IlwZ z 13 1,5- <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 9 <br /> f0 <br /> Relin w ` y Received by Relinguished by Received by <br /> 4 <br /> Date l Time 1�� Date /��1 Time S Date Time Date Time <br /> PLEASE READ REVERSE SIDE FOR TERMS AND CONDITIONS <br />