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200 <br /> ZC04,0LP341 �e <br /> Tf&J"EM10 CHNN OF CUSTODY RECORD Page of 2_ <br /> Environmental and Geotechnical Consultant 555 Montgomery Street,Suite 1300,San Francisco,CA 94111 Ph 415-955-90401 Fax 415-955-9041 <br /> 2 Theatre Square,Suite 216,Orinda CA 94563 Ph 925-25349801 Fax 925-2534985 <br /> Site Name <br /> 501 14th Street,3rd Floor,Oakland,CA 94612 Ph 510-874.45001 Fax 510.8744507 <br /> ���T --,�� <br /> .lob Number Anatysis,,RequesW'd-'� ; <br /> Project ManagerlContact DAVE 11,IJ/15PPIQ O&MIF-49 N. MW <br /> Samplers <br /> Recorder(Signature Required) No Containers'M a <br /> Matrix &Preservative 'a <br /> 01 <br /> CDn e <br /> Field Sample > a °? m` <br /> Identification No Date Time Lab Sam le No : O U N U Q c <br /> JOB 17, <br /> 110$ -12,� Y3ly¢ 16 - X <br /> /1.3 3 u7i h L <br /> I i�2 ! 2-+- -r <br /> o <br /> V 1araLv <br /> 41 N <br /> 8-- -11• % <br /> to 3 <br /> I - -15 +/ A7+ 104 <br /> Resin us hed by ignat Dat Time Rece ved by (Signature) Datyf Time <br /> Rel fished b (Signature) Date Timg� Received by (Signature) ate Time <br /> elrnquished by (Signature) ate Time Recei by Lab {S gnature) Date Time <br /> mina f I Ifo <br /> Sent to Laboratory(Name) Method of Shipment E]Lab oouner 11Fed Ex ElAirbome UPS <br /> Laboratory Comments/Notes �Hand Carried❑PnvateCourier(Co Name) <br /> Whyte Copy-Original Yellow Copy-Laboratory Pink Copy-Field COC dumber 002792 <br />