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Environmental Resources <br /> Management CHAIN OF CUSTODY RECORD 4929 <br /> 1777 Botelho Drive, Suite 260•Walnut Creek, CA•94596•(925) 946-0455•FAX(925)946-9968 Page f of L+ <br /> PRr1.IFrT if PPa IFr.T NIAAAF REQUESTED NAHAME I EH5 <br /> MATRIX <br /> 0(5G6' f� o�G -moto p • <br /> SAMPLER:(PRINT NAME) (SIGNATURE) { <br /> ftC�v <br /> REC MNG LABORATORY <br /> • z (2 4 r <br /> a m SAMPLING w z w€ SAMPLING Q <br /> SAMPLE I.D. DATE TIME METHOD a v� VOLUME <br /> �i11 - 1Sa <br /> vS h <br /> IS Lo <br /> cl <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE I TIME FIELD REMARKS <br /> UT FF <br /> S- OA'( S`TAN'DS "TA <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED DATE TIME <br /> -g/0 6 <br /> RELINQUISHE)-SY(SIGN RE) DATE TIME IVED BY DTE. TIME <br /> ( 74" —N 07 ti-v 7 I0 <br /> MARKS ON MPLE RECEIP ERM REMARKS SEND REPORT TO: <br /> O BOTTLET ODY SEALS O CHILLED p,4ul. �)AVSA4NV <br /> O PRESERVED O SEALS INTACT O SEE REMARKS <br /> Vlur=-LApnonTORY('nov rr6,NARY-PIFLD COPY PINK-DATABASE I GOLD-PROJECT FILE { <br />