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r t ' r - r r r r r r ' r t t r t t r r r r <br /> Environmental Resources <br /> Management CHAIN OF CUSTODY RECORD 4926 <br /> 1777 Botelho Drive, Suite 260•Walnut Creek, CA•94596 (925) 946-0455•FAX(925)946-9968 Page ol, of L4 <br /> PROJECT# PROJECT NAME MATRIX REQUESTED PARAMETERS <br /> SAMPLER: (PRINT NAME) (SIGNATURE) <br /> RECEIVING LABORATORY i �✓) <br /> N'T-2 c14 <br /> SAMPLING w> SAMPLING <br /> SAMPLE I.D. DATE TIME wMETIiOD �� U VOLUME �� 2S IT <br /> a e <br /> s P <br /> 59-9 <br /> -1,0 j16 <br /> F- <br /> 11 �I; T t 7 <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME FIELD REMARKS <br /> _ W�irl�l�i k�� <br /> ELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME <br /> RELINQUISHED BY(SIGN ) DATE TIME A eE2EIVtkBY PATE TIME <br /> MARKS N SAMPLE RECEIPT ERM REMARKS SEND REPORT TO: <br /> ❑ BOTTL INTACT ❑ CUSTODY SEALS ❑ CHILLED <br /> ❑ PRESERVED ❑ SEALS INTACT ❑ SEE REMARKS ! 1 <br /> WHITE-LABORATORY COPY CANARY-FIELD COPY PINK-DATABASE GOLD-PROJECT FILE <br />