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F <br /> 1 <br /> CHAIN OF CUSTODY RECORD <br /> PROJECT NO. SITE NAME b ADDRESS <br /> S .SrsnFt�✓i r�/vr�[xsr.v��� ANALYSES REQUESTED {t� <br /> WITNESSING AGENCY I INSPECTOR NAME!DATE t v <br /> w REMARKS. <br /> x m ,� w <br /> ID NO. DATE TIME o Q SAMPLING LOCATION m O Fx�- <br /> >. <br /> = m <br /> f-- m x <br /> /NF 004713 i t a o X G,�Go" ,�'moi✓ u � ''r t �C f�c� �'ir. ssx�.��eic� <br /> x .voric: El�c.uaT-r r�..er r�*� <br /> f ' <br /> y <br /> . s <br /> 4KLEC_GNE'�� l�r'r3� <br /> attached`Table 2" _. <br /> for specific analysis method. <br /> neli ulsh Signature) Dae Ime Received by: (Signature) The following MUST BE completed by the laboratory accepting samples <br /> Dreg Z3 for analysis: <br /> 1. Have all samples recelved for analysis been stored In Ice? <br /> Relinquished by: (Signature) Dalarrime Received by: (Signa(ure) <br /> 2. Will samples remain refrigerated until analyzed? <br /> Relinquished by: (Slgnahxe) DaterFime Received by: (Signature) 3. Did any samples received for analysis have head space? <br /> 4. Were samples In appropriate containers and properly packaged? <br /> Relinquished by: (Signature) Date/Time MRecd�t Labor ory by,�(S' r>ature)99y ;µ.1 Signature Title Date <br /> C E C 0 r <br /> (W IFORNIA FNVI17rlNh11 rlIAI Fr1r:INrrw, . !'Willi?Af'Iril!'; '"1111IL/I <br />