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COUpT <br /> 2643 N° 0789 <br /> Du Pont Environmental Remediation Services <br /> CHAIN-OF-CUSTODY RECORD <br /> 7068 Koll Center Parkway, Suite 401, Pleasanton, California 94566, (510) 462-7772 <br /> Testing Laborato f G Phone Number <br /> Address 1—N L F- f L;'11- <br /> ZLS-- <br /> 01y, State Zip {7/ S -- <br /> PURCHASE ORDER NO <br /> PROJECT NAME. ALYSIS <br /> SITE LOCATION <br /> JOB NUMBER- 05-11 <br /> REQUESTOR /&C- INh <br /> SAMPLER'S SIGNATURE 1v <br /> S.1AfPLE DA7 TIME COMP GRAB LOCATIONS NO OF SAMPLE REMARKS' <br /> I D CONTAINERS TYPE <br /> 1 <br /> I ZZ ,L(s r A- LA.T <br /> RELINQUIED BY St nature) DATE RECEIVED BY (Signatur DATE <br /> TIME <br /> REPRESENTINdl -1 g' 6� REPRESENTING <br /> RELINQUISHED BY (Signal ) DAT _ /� RECEIVED BY (Signature) T ! DATE <br /> �;;r— TIM � OV4 -1� �ai� TIME t <br /> REPRESENTING ' 7 EPRESENTING � "1 <br /> RELINQUISHED BY (Signature) DATE RECEIVED BY (Signature) DATE <br /> TIME TIME <br /> REPRESENTING REPRESENTING 1 C K- kA p <br /> METHOD OF SHIPMENT OLCir <br /> WH[TF' Return to Client with Report YELLOW Laboratory Copy PINK.Originator's Copy <br /> �' A-4 <br /> i n Y TAT <br />