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Pott-It"brand +�^ <br /> Fax Transmittal Memo 7611 No of Pages Tod at Time V Ory <br /> 7 ( <br /> l <br /> `4 : <br /> Com - QT �� comps y SAN JQAQM COUNTY <br /> Location Location PMI.IC HEe RVICES <br /> BNVIRONAIBNT� IDIVISION <br /> Fax \ /7/� T[I�hona# Fez# POs'(' =9 <br /> / Com /O (� Original Destroy <br /> Return cal•�o�p pickup <br /> Disposition: <br /> Collector LI /`W/Q�.�/�l P1 <br /> Sampling Location <br /> (Provide sketch on back and match sample E with sampling location) <br /> Suspected Toxic Connstituents_9e4s0I.,%A(I .0 Pl ClJO.•/ <br /> S <br /> Field Conditions i how sm ,ol/ pe si eO Ac t.4ri •0• <br /> Sample Depth/ Time Sampling <br /> Sample I Type Drumr, Sampled Method Notes <br /> .(For more than 4 samples , attach a Continuation Sheet) - KNc:L ) <br /> LABORATORY ANALYSIlIN �` •?• �• •1``t )(7� °)Z <br /> �-- l G t <br /> Laboratory_ r t, �p /{C Contact/B}-igne 41-4 <br /> , M M <br /> Date/Time Samples Delivered /_ y, �/� 11 AErz PILI <br /> Report Due Date <br /> Analysis Requested <br /> t <br /> Send results to AEMC Laboratory , At�terfion : / <br /> Sample Retention Instructions J 1 <br /> CHAIN OF CUSTODY <br /> Relinquished__ by (Company) Received by (Company) Date/Time / �✓ <br /> �iqt� � ( �q��,c9� fti::�,N,.,•/9/ tZZ 3 TSS-4 J' <br /> AMERICAN ENVIRONMENTAL MANAGEMENT CORPORATION <br /> 11855 White Rock Road, Rancho Cordova, CA 95670 (916) 985-6666 <br /> FORM 20-52 <br />