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Environmental Resources <br /> Management CHAIN OF CUSTODY RECORD 4928 <br /> 1777 Botelho Drive, Suite 260•Walnut Creek, CA•94596 (925)946-0455 FAX(925)946-9968 Page _ — Of <br /> DonIFl:T f! PRO ECT ALAME REQUESTED P'ARANIt 1 this <br /> MATRIX <br /> G TIN <br /> SAMPLER:(PRINT NAME) (SIGNATURE) <br /> Como, McCbliouK <br /> RECfIVING LABORATORY <br /> 0 <br /> d m SAMPLING w Z w SAMPLING (L �^ <br /> SAMPLE I.D. DATE TIME aa�C METHOD ¢ 2> VOLUME <br /> !1 <br /> ��e - <br /> �' f x <br /> S <br /> to V s X 0 <br /> 3 <br /> ()L5q Avg ft <br /> Pi <br /> ° <br /> t3 , <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME FIELD REMARKS <br /> WA0JV-c E-k-.r-: 04:PIC-P S7 DAY 5 i DA42D ?h" <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVE DATE TIME <br /> 411 00 <br /> RELINQUISHED B (SIGNA ) DATE TIME RECEIV Y DATE TIM <br /> E RKS N SAMPLE RECEIPT ERM REMARKS SEND REPORT TO: y , <br /> ❑ BOTTLE INTACT STODY SEALS ❑ CHILLED <br /> ❑ PRESERVED ❑ SEALSINTACT ❑ SEE REMARKS <br /> V..... -LAP--'-ORY`nrw • -NARV r'cLD C(` n""K-Df`TADASE GOLP DDOJEqT cn c � <br />