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Environmental Resources CHAIN OF CUSTODY RECORD <br /> Management • sP: 7170 <br /> `" 3 <br /> 2525 Natomas Park Drive, Suite 350 •Sacramento, CA • 95833 • (916)924-9378 FAX(916)920-9378 Page of <br /> PROJECT# `PROJECTNAME (1'EQ�j QED-F�IRAMETE{� ` <br /> �� ��L CuY�r�o �Y1('-,. ��"T�.� +�l✓l. • MATRIX.. 1 <br /> u y <br /> SAMPLER: PRINT NAME (SIGNAT RE �J I� ,,`,``� �} ' <br /> W z ? r <br /> ill, I II ((U�lVd. / UCL • z N <br /> RECEIVING LABORATORY. = <br /> L,—� • <br /> m. SAMPLING pRESER ICE SAMP)_ING <br /> SAMPLE I.D. DATE TIME. n4- R (` - <br /> METHOO 'VATIVE YIN• VOLUME:. L 'J h{ -� , - 1`r:� I�� <br /> - L 17-L-G QC / Wnc< }J,`l }I L<IU I ! < x <br /> v <br /> Q, ( O I�: 0 ! 1�> Y � x <br /> '4 l_'N i Cr x u <br /> Y <br /> RELINOUISHE ABY SIGNAT RE i - -.DATE TIME .. 'REC BY DATE TIME :FIELD REMARKS' <br /> I r <br /> R QUIS ED BY(SIGNATURE) DATE -- -TIME. RECEIVED BY - - <br /> DATE TIME <br /> TfME �t'v <br /> f� <br /> RELINQUISHED BY(SIGNATURE) DATE. TIME - RECEIVED BY - DATE TIMEJ,C��r <br /> REMARKS ON SAMPLE RECEIPT - - ERM REMARKS ]SEND REPORT TO: < <br /> ❑BOTTLE INTACT ❑CUSTODY SEALS ❑CHILLED \ /G <br /> ❑ PRESERVED ❑SEALS INTACT ❑ SEE REMARKS <br /> WHITE-LABORATORY _ _ PINK- DATABASE MANAGER GOLD-PROJECT FILE ;. <br />