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maim <br /> AGER TECHNOLOGY, INC. 4_3 CHAIN OF CUSTODY RECORD <br /> Analytical Laboratory Phone (918)382 8947C.O.C., NO. 2 5 5 2 3 I <br /> 3050 Fite Circle,#112 Sacramento,CA 95827 FAX (916)362-0947 Pae of SIAL Invoice Number <br /> Company A 4 m q'G f n V i r V R tMe k h r j Phone (31k) 3S4 -3Z50 ANALYSIS REQUEST <br /> Project Manager Toe A q y-i 'ta FAX (9W 3S4- 31S I REMARKS Sampler's Name <br /> Report Address Btlling Name&Address S q w1 j_ <br /> '�& 10 C911toV11, Wg31 SNI Vo 7-00 r►ta <br /> RR N c lto M M r NN- j CA .9S6 93 All None Same <br /> Project Name Project/Job# OK OK OK WET STLC <br /> SAN Tvgtaiw C4 t4011'C CeWeift_y Cooler Temp °C <br /> Project Location PO# Sample Condition TCLP <br /> Stochtv4 CgIifor4t'A, H <br /> Preservative TCLP Total <br /> Sampling Container Used Matrix TAT <br /> z <br /> N O <br /> � � C <br /> is N Qy cp Q^ d CD <br /> L <br /> V <br /> N <br /> Ln CL <br /> N = Q. <br /> cA O O N y U cA ay t 4 N CL <br /> T] <br /> V <br /> M W N y = ,� o C7 �, <br /> j N U aD in d O N c00 coo 7 0 � H w Y <br /> a Q a a2 0 'Co � W m c'R C'JO O J m t m <br /> O _m `m d o m <br /> 7 � z 4 O co O N N a c? n n D7 <br /> CA tti q� W <br /> COO y X 'O w co w w w cD d c �" cy <br /> NO SAMPLE!D Date Tlme a J _ o o _ Y Iw H a iiC �a a a a Qa o o 21 0 ¢ a = H 0 <br /> m .- o = z O cn O m m w w w w w w z o o_ U U tin ¢ x° <br /> 1 M - ? 1010 <br /> �( X <br /> 3 VW - %' X d3� x X X <br /> 4 v W-1 1040 x X XX <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 1 t I <br /> RelinALkished by Received, Relinquished by Received by <br /> 1. <br /> Date $ 9 8 Time 1 0 b Date 7 Time I Date Time Date Time <br /> PL ASE READ REVERSE SIDE FOR TERMS AND CONDITIONS <br />