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04 I s 4 P I 9co <br /> TreadweIEMlo CHAI OF CUSTODY RECORD Page of?� <br /> Environmental and Geotechnical Consultant 555 Montgomery Street,Suite 1300,San Francisco,CA 94111 Ph 415-955-9040/Fax 415.955.9041 <br /> 2 Theatre Square,Suite 216,Orinda CA 94563 Ph 925.253-49801 Fax 925-253-4985 <br /> 501 14th Street,3rd Floor,Oakland,CA 94612 Ph 510.874-4500!Fax 510.8744507 <br /> Site Name A'j[p <br /> Job Number Artalys[s Requested , <br /> Project ManageAContact C /J 'fAt)v(,O ' -G p <br /> I am MIR I <br /> Samplers j <br /> Recorder(Signature Required) CL <br /> 5 <br /> No Containers <br /> Matrix &Preservative fi <br /> Field Sample o <br /> Identification No Cate Time Lab Sample No C o v, r <br /> Regi q shed b 5 ) Date Time Re ed by (Signature) at Time <br /> �7� 3 3a o � 3 a <br /> Rel i hed by (Signature) Date Time _ / Received by (Signature) IDAte Time <br /> Relinquished by (Signature) Date Time Received by Lab (Signature) Date Time <br /> -ao - o a <br /> Sent to Laboratory(Name) Method of Shipment Lab couner [:]FedEx [:]Airbome E:]tjPS <br /> Laboratory CommentslNotes Hand CamedllPnvate Couner(Co Name) <br /> White Copy-Original Yellow Copy-Laboratory Pink Copy-Field COC Number 002796 <br />