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lam`' <br /> Kennedy/ Ncs/Chilton, Laboratory Division <br /> } Subcontract Sample Chain of Custody Record <br /> Source of Sample(s) , KENNEDY/JENKS/CHILTON Subcontract to <br /> Address 674 Harrison Street Attention <br /> San Francisco, California 94107 Address <br /> Phone ( 415 ) 362-6065 <br /> i <br /> Report to (1) Leverett Smith or Ted Nakamura Phone <br /> Sample Information K/J/C Job Number <br /> Type <br /> Lab No. Field No. Date Time __ 2� Oepth Remarks (Suspected Contaminants, <br /> Field Conditions, etc.) <br /> -air <br /> qo Y2 <br /> W&,CA-4A,rCLLjjy. <br /> 3 5 <br /> Chain of Possession <br /> Relinquished by Date Time Received by (3) Date Time <br /> (Si natu a and of ilii -1 (Si nature and affiliation) <br /> S <br /> zlkz <br /> 2. <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 /> (12188} <br /> pl- - <br />