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CHAIN OF CUSTODY RECORD <br /> PROJECT NO. SITE NAME&ADDRESS <br /> ANALYSES REQUESTED its <br /> WITNESSING AGENCY!INSPECTOR NAME/DATE m <br /> :4 <br /> w REMARKS <br /> p X <br /> ID NO. DATE TIME SAMPLING LOCATIONCO X Co x <br /> z m <br /> !x: <br /> . J< tcL.15 <br /> rl6d <br /> •n <br /> `' (1) See attached'TaMe 2" <br /> for specific anatysia method. <br /> Relinquished by: (Signature) DatelTime Received by: (Signature) The fallowing MUST 11 completed by the laboratory accepting samples <br /> 5A AA for analysis: <br /> �Urtb� y�Nrr 1. Have all samples received for analysis been stored in ice? <br /> Relinquished by: (Signa (&) Date/Time Received by: (Signature) <br /> 2. Will samples remain refrigerated until analyzed? <br /> Relinquished by: (Signature) Date/Time Deceived by: (Signature) 3. Did any samples received for analysis have head space? <br /> 4. Were samples in appropriate containers and property packaged? <br /> Relinquished by: (Signature) Date/Time d for Labora ry by: (Signature) <br /> i6l � � <br /> iZ S� r/r Signature Title Date <br /> CtECON <br /> CALIFORNIA ENVIRONMENIAt E.NCINECR . & CONIRACrors <br /> 1� PAI OHA A' [ 1`A('II I,'n 'n 'l t11 I <br />