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} 1 <br /> i P Kennedy/Jenks/Chilton, Laboratory Division <br /> U <br /> Subcontract Sample Chain of Custod Record <br /> Source of Sample(s) KENNEDY JENKS CHILTON Subcontract to bj� COZJ llavtj <br /> T� Address 674 Harrison Street Attention <br /> San Francisco California 94107 Address �d <br /> T Phone ( 415 ) 362-6065 J4 , CA 9 �5 <br /> Report to (1) Leverett Smith or Ted Nakamura Phone ( 702) q�LZ y(n �{`� <br /> Sample Information K/J/C Job Number <br /> Type ... <br /> Lab No. Field No. Date Time �2 , Depth_ Remarks (Suspected Contaminants <br /> Field Conditions, etc.1 <br /> 171 spy <br /> 72. Cr&T <br /> Chain of Possession <br /> Relinquished by Date Time Received by (3) Date Time <br /> (Siginature and affiliatio (Signature arld affiliation) <br /> 12 <br /> 1 <br /> 1 - L <br /> Logged in at K/J/C by <br /> (1) A separate Request for Analysis form is to be filled out by the collector and given to <br /> the Laboratory when samples are delivered. (2) e.g. water, sludge, soil , etc. (3) If any <br /> samples are not intact at time of transfer, please describe on the back of this form. <br /> WARNING: These samples contain unknown chemicals which, upon analysis, may be determined to <br /> be "known to the State to cause cancer or reproductive toxicity", under the California Safe <br /> Drinking water and Toxics Enforcement Act of 1986 (Proposition 65). <br /> � K � (12/88) <br />