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I' <br /> ON-SITE 0 <br /> To - - <br /> e� TECHNOLOGIES <br /> (LaboraloryName) CHAIN OF CUSTODY RECORD 1716 S.BasoomAvaeue Campbell CA 9600a <br /> (408)3714810 FAX(408)371-2010 <br /> PROJECT NO, SITE NAME A ADDRESS TURN AROUND TIME <br /> Ao l'-f O a d 11, 61,vif ANALYSES REQUESTED FOR ANALYSIS <br /> 7z)/`r•.20 24 HR 0 48 HR <br /> !0481 �sre, , dd 2 6 <br /> ? <br /> SAMPLERS'(SIGNATURE) ^,� m� w 0 5 DAY © 10 DAY <br /> x Qa CDI ' STANDARD <br /> 0 OTHER <br /> ID NO DATE TIMTEo_ SAMPLING LOCATION o x r <br /> ��- 10REMARKS <br /> �w- ru A f D1Crt, I X <br /> r � x <br /> �w_ a X <br /> Report Atin- <br /> Rio A 6qj,-1 w <br /> Relr uished by. (Signature) f)ate�me ace y (Signature) The following MUST Be completed by the laboratory accepting samples for <br /> la`a5 analysis Please check Yes or No. <br /> eo h 1 l 1 Nave all samples received for analysis been stored in Joe? Ci Yes 0 No <br /> elrnqu4sh , <br /> (Signature) f]ate�ma ecelved by ( rgnature) 2. Will samples remain refrigerated until analyzed? O Yes 0 No <br /> 3 aid arty samples romwod for analysis have head space? 0 Yes 0 No <br /> 4. Were samples in appropriate containers and properly <br /> packaged? O Yes 0 No <br /> Relinquished by. (Signature) Dateff Ims Received by (Signature) .5. Chain of custody seal intact? 0 Yes 0 No <br /> Signature Title Dale <br />