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CHAIN OSTODY RECORD <br /> DATE PAGE�_0FEnvironmental <br /> PROJECT NAME Air,' Lodi ANALYSES TO BE PERFORMED MATRIX Science & <br /> ADDRESS_59 1-6e AIe.n N o Engineering,Inc. <br /> M .OLCOR►D-W y <br /> T B T A MN (415)372-3637 <br /> 1 597 Center Avenue <br /> PROJECT NO. to 90 5030 R E A Suite 350 y <br /> I R I Martinez,CA 94553 Fax(415)372 37% <br /> SAMPLED BY (nOr,ZrJC 2— �u x X 0 E <br /> LAB NAME cit.r-7 S d F S REMARKS <br /> SAMPLE # DATE TIME LOCATION MATRIX (CONTAINER, SIZE, ETC. ) <br /> L& wa+e r <br /> I t l to; A 4vefba <br /> MW,,I- I IlWejo ' I X P/rff CaU Panc-Ao <br /> t of <br /> -2-3 te- l - (n 7 <br /> Lodi <br /> RELIN UISH BY: (signature) I nature) d time TOTAL NUMBER OF CONTAINERS <br /> 1. r i <br /> REPORT SPECIAL SHIPMENT <br /> 2 . RESULTS TO: REQUIREMENTS <br /> 3 . <br /> 4 . <br /> 5. SAMPLE RECEIPT <br /> INSTRUCTIONS TO LABORATORY (handling, analyses, storage, etc. ) : CHAIN OF CUSTODY SEALS <br /> P CCIS�' f Glue GAI0C Repov-t W]-{'I1 Ganec.Iy,s RECtD GOOD CONDTN/COLD <br /> CONFORMS TO RECORD <br />