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CHAIN OF CUSTODY RECORD <br /> PROJECT NO. SfTE NAME✓i ADDRESS <br /> �CQ �7�Nf UfNL`�°ArlZd�S ANALYSES REQUESTED (1� <br /> WITNESSING AGENCY/INSPECTOR NAME/DATE m <br /> S: C.) <br /> w -0 m Z <br /> CRzaj REMARKS <br /> w <br /> a <br /> ID NO. DATE TIME D SAMPLING LOCATION f = m z E m <br /> 0 % � D <br /> 11-2-13 6840 K Gi(2�Nd t�1r� `i►eL �i'"l�l,�T <br /> ,�FF-GT5 q- 4o x <br /> Y <br /> 'SAM <br /> { <br /> (1) See attached"Table 2' <br /> y for specific analysis method. <br /> Roll is (Si nature) Date/Time ivedy: (Signature) The following MUST BE completed by the laboratory accepting samples <br /> for analysis: <br /> [[ 1. Have all samples received for analysis been stored in tce? <br /> lqui by: (Signature) Date/Time Receive b (Signature) <br /> 2. Will samples remain refrigerated until analyzed? <br /> Relinq Ish by: (Signature) Date/Time 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 R 'd for Labor tory by: (Signahrre) <br /> g �q3 111° <br /> Signature. Title Dale <br /> w— <br /> CALIFORNIA ENVIRONMENTAL ENGINEERS & CONTRACTORS <br /> 1517 PALMETTO AVE STE 4, PACIFICA CA 94044 (415)'738-1115 <br /> �w� <br />