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- CHAIN OF CUSTODY RECORD <br /> PROJECT NO. SITE NAME&ADDRESS T. <br /> ��ST SE�AS`J1A7.1( V(NOYAYU> ANALYSES REQUESTED fit) <br /> Tu l2NE}2 fR lJ, !�0(�i Ca <br /> ix: N <br /> WITNESSING AGENCY/INSPECTOR NAME/DATE CD <br /> UjU <br /> LU <br /> 0 (D W REMARKS <br /> 40 E o .e C ,s <br /> ID NO. DATE TIME -� SAMPLING LOCATION v m x <br /> C) Q � <br /> cn ►— I z m :E <br /> X75� f N ' I Uo8-9z !/�-o �' 7��-7���✓r sx-s ra7c2 K <br /> <ZV Pr2---s <br /> 5D �N Q�I/L <br /> :f <br /> ff: <br /> (1) See attached'Table 2' <br /> for specific analysis method. <br /> Relin s Signature) Date/Time Received by: (Signature) The following.MUST BE completed by the laboratory accepting samples <br /> $or analysis: <br /> 16)41 o 'od 1. Have all samples received for analysis been stared in ice? <br /> elinquished by: (Signature) Dataffime Received by: (Signature) <br /> 2. Will samples remain refrigerated until analyzed? <br /> Relinquished by: (Signature) Daie/Time Received by: (Signature) 3. Did any samples received for analysts have head space? <br /> 4. Were samples In appropriate contairiers and properly packaged? <br /> Relinquished by: (Signature) Date/Time Rec'ddJfor La rate by: (Signa r ) <br /> / (' 1 r? Q L Signature Title Data <br /> E <br /> �b= <br /> C 0 N <br /> CALIFORNIA ENVIRONMENTAL ENGINEER; &. CnNTRACTORS <br /> i 7 f nl nein nvf I'nr l u'n rn uin r <br />