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0& <br /> CH 4 r <br /> TreadWdEM10 AIN OF CUSTODY RECORD Page v of <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 /> 501 14th Street,3rd Floor,Oakland,CA 94612 Ph 510-874.45001 Fax 510-874.4507 <br /> Site Name �jT(� �� <br /> Job Number 2�� p AnalyslskRequest-d _ y4 <br /> Project ManagerlContact C {� �� ,� N <br /> Samplers e <br /> Recorder(Signature Required)- 1 e <br /> tA Na Containers <br /> Matrix &Preservative �L <br /> Field Sample" .4 o ' a� {_ <br /> (h Identification No Date Time Lab Sample No n �, <br /> \ 1!vB-lv�I�G ►/r3✓ 13� 2Remarks 'a P✓h <br /> -t �-r?kr <br /> - O`7 12x:'7ITF_ 2A <br /> t l b ~6`I3.S t7 <br /> � <br /> z D Z <br /> B—E ln/ $35 2�1-_N-12 <br /> R h quishe t ) Dae n Time Recet by {Signature) Date Time <br /> e in h d y (Signature) Dat a / <br /> Time Received by (Signature) 16ale Time <br /> Relinquished by (Signature) Date Time Received by Lab (Signature) Date Time <br /> lS�y� <br /> Sent to Laboratory{Name} <br /> Laboratory Comments/Notes Me od of Shipment MLab courier [:]FedEx Dfurbome [:]l1PS <br /> Hand Carried❑Private Courier(Co Name) <br /> White Copy-Original Yellow Copy-Laboratory Pink Copy-Reid COC Number 002791 <br /> M MONO M <br />