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Environmental Resources <br /> Management CHAIN OF CUSTODY RECORD • 4926 <br /> 1777 Botelho Drive, Suite 260•Walnut Creek, CA•94596 (925)946-0455 a FAX(925)946-9968 Page of <br /> PROJECT# PROJECT NAME REQUESTED PAHAME E ERS <br /> MATRIX <br /> CSO 6 6 a " /X-L SII U 03t -- <br /> SAMPLER:(PRINT NAME'S (SIGNATURE) <br /> r, <br /> RECEIVING LABORATORY _ • ;✓il <br /> SAMPLE E.D. DATE TIME a SAMPLING Uj> SAMPLING Q {� <br /> METHOD a U� VOLUME <br /> 6E r;O /t 1J i <br /> pus <br /> S (� <br /> tS, <br /> a '►(q <br /> 4- �! D� T �( t <br /> 53-q-5�� <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME FIELD REMARKS <br /> 1 <br /> w4L_>�� E- � S- DAY S7'A1,)D�J2J T-4T�°�' 1800 <br /> r—ELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME <br /> VV C- ° . ' ,e;m -.��.r�Zd �I /o� ��. %1 IDS <br /> RELINQUISHED BY(SIGN DATE TIME A dFECEIY ,BY AT_E TIME <br /> 177111 <br /> MARKS N SAMPLE RECEIPT ERM REMARKS SEND REPORT TO: <br /> ❑ BOTTL INTACT ❑ CUSTODY SEALS ❑ CHILLED �f}V L �vSK49. J <br /> ❑ PRESERVED ❑ SEALS INTACT ❑ SEE REMARKS 1� <br /> vp--LAP-D"TORY rn— rXNARY-t=iFLD COPY PINK-D.QTORQSE GOLn-PROJECCT FII E <br />