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ERM-West Date Weather Page of <br /> 1777 Bot elho Drive,Suite 260 • Walnut Creek,CA • 94596 • (510)946-0455 Chain of Custody Record <br /> Job# ERM-West 2058.00 Collection <br /> I I Inorg Other Remarks <br /> IT <br /> ' � <br /> Job location <br /> Sampler(signature) 1 <br /> Printed name 1 1 ! i <br /> Jahn White : � <br /> P P Jeff Rubin _ ; _ _ II m <br /> Lab Report Recipient • ! l <br /> .Telephone No. .(209)275 2t 75 _ _ ! r$ <br /> u rill= G <br /> ! <br /> Receiving Lab Labs Glen Brown <br /> m ! <br /> Address 4203 West Swill m i i m 5 <br /> Fresno CA 93722 C <br /> c d: v� I <br /> W-avatar C_comp Vol, — o E I r <br /> I c l <br /> x Z <br /> Time <br /> Sample rab me <br /> = <br /> i ; <br /> ............................... ................ ..... ..........:....................... .....:............:....._._........... i <br /> i .......... •... .................. <br /> ................. .......................................................... ................-.....r.......... % ....... i•....;....- ...�...... j...-._ <br /> I ! i <br /> ..........- ................................... ......... :.. .........;.....--._..... <br /> j <br /> r <br /> 1 I <br /> --................................................. ................: --....---..-:....... r.._..,....... ..:........._..; <br /> .. ..•..... <br /> ; <br /> IEE <br /> E ! i ! i r I s i ' _................. <br /> ........................................... <br /> E _ i j.. <br /> = r--.......... ..........y._....r._._..t.. l <br /> , <br /> i <br /> ............ ....................... i . 1 <br /> = I 3 <br /> Precautions: Conc: [,Lo0 Med[]Hi Ship Via Total Number of Containers: <br /> Sample Relinquished By Dale Time Received-By Dale Time Reason for Transfer(List Shipping Bill Number) <br /> .................................................................................................................................. ....... <br /> Cornany........... ...................... ...... ................ ........ Company <br /> ....................................... ................ .............................................. .......................................... .............._..........._......... ........----.....--.._ ............ <br /> Com an Com an <br /> LABORATORY— Ej samples 0 Samples Samples Q A of containers a Container tags Cooler seals — — <br /> Please Complete Intact at 4"C not leaking matches C-of-C match C-ol-C _ Intact _ _ J <br /> L.ab sample custodian — Signaturo Date limn TSampto Disposition Return to Site Q t7tscard 0 Hold days <br /> W - — —. - — — — — — — - — — — — — 1 — — _._. — — — — — — — — — — — — — �ro.�a.9x��w � <br />