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CHAIN-OF-CUSTODY RECORD <br /> k/r� 22274 <br /> INDUSTRIAL COMPLIANCE 9838 OLD PLACERVILLE ROAD, SUITE 100 - SACRAMENTO, CA 95827-3559 • Phone 916-369-8971 FAX 916-369-8370 <br /> PROJECT NAME PROJECT LOCATION <br /> C/y ANALYSIS DESIRED <br /> , (INDICATE <br /> PROJ.NO. PROJECT CONTACT PROJECT TELEPFIONE NO. U) SEPARATE V <br /> *%0 Cl \\(D��{o� `��� tt Z CONTAINERS) <br /> CLIENTS REPRESENTATIVE PROJECT MANAGER/SUPERVISOR to I <br /> �Z i <br /> Z U 9 <br /> 2 IL to SAMPLE LOCATION O � <br /> NUMBER DATE TIME bb (INCLUDE MATRIX AND Q <br /> * c3 [7 POINT OF SAMPLE) <br /> IL2 REMARKS <br /> 2 3..5 N a$ -/dy I <br /> 4 b�+c� <br /> X1 .5 —\D') <br /> `1 I <br /> s 5by-�v� <br /> s Sc3-col 0155 <br /> 7 sa-of <br /> IO55 <br /> 3.5-H, <br /> REMARKS <br /> ITEM TRANSFERS TRANSFERS <br /> NUMBER RELINQUISHED BY ACCEPTED BY DATE TIME <br /> 5 ow <br /> + j X" S��S , l ir., Z C� V,0\A <br /> 2 <br /> !.'/ dfiy- AY,97 /S tor{-:a�. , s S.�\� c�..�:u1A <br /> SAMPLER'S NAME SAMPLER'S SIGNATURE <br /> / LABCOPY <br />