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KIS CHAIN OF CUSTODY RECORD <br /> SEND RESULTS TO ALL PARTIES LISTED BELOW: <br /> "If <br /> ° Fionn O'Neill Fionn@kleenblast.com <br /> . IV <br /> Industrial Services <br /> 50 Oak Court, Suite 210 <br /> Danville, CA 94526 <br /> Phone 925-831-9800 —Fax 925-831-9183 <br /> Project CLIENT <br /> Number 't"!: I I" T AIL ISL Ir�1Ai11. P(• �(Xf ht1 t� ) ` <br /> JOSSITE, <br /> COLLECTED BY 1 <br /> SPECIAL <br /> INSTRUCTIONS: <br /> (>I CAM 17-TTLC, STLC 10x RULE, TCLP as needed <br /> ANALYSIS ( 1 8 Metal TCLP SELECT THE 72hrs Standard Rate <br /> REQUESTED ( 1 17 Metal STLC TURNAROUND ( ) 48hrs SR + 25% Premium <br /> ( ) Other, Note in Special Instructions Section TIME DESIRED BY ( ) 24hrs SR + 30% Premium <br /> MARKING OR ( ) Same Day SR+50% <br /> HIGHLIGHTING. <br /> Sample ID Lab ID Collection Matrix Notes or Sample Map, Etc. <br /> --___--- Date <br /> kir, <br /> Ir -- - - 2 1 I !/ Solid <br /> -- - , Solid <br /> --- ; Solid <br /> By my signature below I attest that this sample was collected in accordance with KIS'sample directive S0P#1-B or by oil �regulatory compliant means. <br /> Gate r 1 <br /> i c r II ���' Received By. <br /> - I Date <br /> --. I__I— �/1` /� r <br /> Tim <br /> •'/ <br /> Relinquished ey' <br /> Date Received By t <br /> & Time i i Date <br /> Rel.ngwshed By &Time <br /> Date Received 8y. <br /> & <br /> Time Date <br /> &Time <br /> Send Sample To: Enviro-Chem, Inc. Laboratories <br /> 1214 E. Lexington Avenue <br /> Pomona, CA 91766 <br /> Ph 909-590-5905 <br /> Fax: 909-590-5907 <br /> CA-DHS ELAP Certificate #1555 <br /> �!C i v ir5!<rn:hce 4• -t.n'r.w4'i"•:i , ri. VianAnul ioi. <br />