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ON-SITE <br /> TECHNOLOGIES <br /> TO (Laboratory Name) CHAIN OF CUSTODY RECORD utas aesoornAvenue ca ell.cAasoos <br /> (408)371-4810 FAX(408)371-2010 <br /> PROJECT NO. SITE NAME&ADDRESS AMT-f-0- <br /> =, TURN AROUND TIME <br /> ANALYSES REQUESTED FOR ANALYSIS <br /> a <br /> O 24 HR © 48 HR <br /> m (Dz ro o s DAY o 10 DAY <br /> SAMPt.>EIiS:(SIGNATURE) -es C7 %a TANDARD <br /> F.7 <br /> O OTHER <br /> ' ID NO. DATE TIMEO SAMPLING LOCATJON z a Ed [LC ac <br /> _ 3 ►- REMARKS <br /> Spl� rn�z B7�'3a- PC x <br /> 6�1 rdr�i3 f3'oa RW3 <br /> 7 ll-tyt� 49l� >C <br /> 1TV1-39 <br /> dO- <br /> Report Attn. <br /> n ' 0>1 ad <br /> Relinquished by; (Signature) Dale/Time Received by (Signature) The following MUST Be completed by the laboratory aocepting samples for <br /> _ analysis Please check Yes or No <br /> 1 Have afl samples received for analysis been stored m cal el}fes O No <br /> Relrr�qu1i Sign ure) Date�me Received by (Sig ature) 2 Will samples remain refrigerated until analyYed? t�Yes O No <br /> 3 Did any samples received for analysis have head space? ©Yes �Vo <br /> ^ 4. Were samples <br /> a appropriate containers and properly <br /> M •° `�^ packaged? ®Yes D No <br /> ReGrxjurshad bar: (Signature) DaleMme Recet ed b ,` (Signature) ' 5 Chain of custody seal intact? ©lies ❑No <br /> Signature Title Date <br />