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Environmental Resources <br /> Management CHAIN OF CUSTODY RECORD 4860 <br /> 1777 Botelho Drive, Suite 260•Walnut Creek, CA•94596•(925) 946-0455•FAX(925)946-9968 Page L4 of ? <br /> PROJEECT# PROJECT NAME REQUESTED PARAMETERS <br /> oego 0-�Gq DPL- 1'M`©N P MATRIX <br /> • <br /> SAMPLER:(PRINT NAME) (SIGNATURE) <br /> RECEIVING LABORATORYLa <br /> SAMPLE I.D. DATE TIME g SAMPLING co w2-SAMPLING <br /> METHOD Q v VOLUME , <br /> I�- Iana if � �� c► o,�,� 3 X, <br /> RELINQUISHED BY(SIGNATURE) DATE TIME RECEIVED BY DATE TIME FIELD REMARKS <br /> - /a*+19a0 amcz— <br /> RELINQUISHED BY(SIGNATURE) DATE TIME EIVED BY DATE TIME <br /> 4--�w zbn::��:k 1410, /60V <br /> RELINQUISHED B)41—GNATJdWp DATE TIME CEIV BY DA E TIME <br /> E ARKS N SAMPLE RFC lPTNE-PMREMARKS SEND REPORT TO: <br /> O BOTTLE INTA T ❑ CUSTODY SEALS ❑ CHILLED R,$A- HhQSM, P),) <br /> ❑ PRESERVED ❑ SEALSINTACT ❑ SEE REMARKS <br /> WHITE-LABORATORY COPY CANARY-FIELD COPY PINK-DATABASE GOLD-PROJECT FILE <br />