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DeMenno/Kerdoon <br />"Recycling For A Cleaner Environment" <br />2000 North Alameda Street - Compton, CA 90222 <br />age <br />(310) 537-7100 Fax: (310) 639-2946 <br />CA -DHS ELAP Certificate #2037 <br />0% L— <br />t;nain of Custody <br />Date i'l-3-Ol—Page I of / <br />I Contact: - Te 1( -20 1 Fax: <br />Client: +i V'\ - q- eOF -031 <br />-s. <br />Addres 0 L, City: State: Zip Code: <br />CA <br />Project Name: Sampler(s) Signature: <br />Project Manager: Approved By: <br />Due Date LJ Regular [J Rush Days Comments: <br />Sample Description <br />Lab <br />ID <br />Date Time <br />Collected <br />Matrix <br />No. of <br />Containers <br />Analysis Requested <br />h'Z-- 0 1 <br />0/ (1,0 0 <br />If -,-3c) <br />CAM I T-� 1+ ID ,e4 d - M-hw- O� I <br />Sample Conditions: Seal D Intact D Broken [J None; Temperature L] Cold [J Room; Other <br />Relinquished by (Signature)Received by (Signature) Date/Time 1-13-01/IF,- yS- <br />-1-4 14 <br />Relinquished by (Signature) Received by (Signature) ,,c��_ �Date/TimEb <br />Relinquished by (Signature) Received by (Signature <br />Date/Time <br />SPECIAL INSTRUCTIONS <br />fl VAV\,1R64eA4Cr- (S" -,L)Vr- &� c v -e4,16 <br />