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DeMennolKerdoon <br />A- "Reryding Ftyr.4 Cleaner Environment" Chain of Custody <br />�-,000.'Vorth Alameda Street • (ompf(in, CA 00-222 <br />(310)537-7100 Date -Z . ....... Page of--L- <br />CA-!)FLS E1AP(.'u"0(wte #aa37 <br />Client: C -pt Contact: 1J, -4,111-h L,40( Tel: 2,0Fax: <br />Address: �s2, <br />City: State: Zip Code: <br />Project Name:Lj"k, S I tc�Sampler(s) Signature: <br />Project Manager: Approved By: <br />Due Date U Regular Ll Rush Days Comments: <br />Sample Descriptimi <br />Lab <br />ID <br />Date Time <br />Collected <br />Matrix <br />No. of <br />Containers <br />Analysis Requested <br />Sample Conditions: Seal LJ Intact <br />Relinquished by (signature) <br />Relinquished by (Signature) <br />Relinquished by (sig <br />SPECIAL INSTR <br />i none; Temperature J Cold L) Room; Other <br />Received by (' Sigriatul-e) <br />Received by (sigwztureA <br />Received by (sigiiutw-4 <br />WHITE COPY—Client PINK COPY — Courier <br />Date/lime -2 -17 -11 1 <br />Date/Time -0 <br />Date/Time <br />fe <br />