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( 0 CID <br /> 48110 v13-3 19- <br /> CLIENT CHAIN OF CUSTODY RECORD <br /> NAME 0;own&Caldwell REQUEST FOR ANALYSIS C K Y incorporated <br /> ADDRESS DATE Z' x E - to Analytical Laboratories <br /> CA 9 630 Maple Ave <br /> PAGE OF Torrance,Calif 90503 <br /> PHONE NO 540 937 9090 FAX NO 340.947 9M Tel 310-618 8889 <br /> PROJECT NAME EZ—SMW STOC #"100 �(, I X 003 06- Fax 310 618 0818 <br /> SEND REPORT TO Todd <br /> SAMPLER NAMEISEGNATURE <br /> TURNAROUND TIME ANALYSES REQUIRED <br /> r <br /> NORMAL KI <br /> C <br /> f,EvIN . M -1vftW,4 RUSH ❑ _ `" $_ $ <br /> SAMPLE SAMPLING PRESER I CONTAINER SAMPLE DESCRIPTION71 $ Ri g o <br /> NUMBER DATE/TIME VATIVE SIZE[TYPE WATER SOIL OTHER `r $ QD � U <br /> r 100 -T�3 2 2(Ato _Nw pa 1-5.X404JOA X 7( X <br /> Z 1009E16 - 1134 <br /> 100 6lo- w- -4 1.530 <br /> I0ogbl^-MW-3 1b Z <br /> 1004bb-MW-,- 1533 <br /> 0096b-Mul-S rZIg <br /> -MW- X1+3 f 2Z <br /> t O -MVJ-(� JIM, <br /> /0 ebb- W-T pqr <br /> N 10 bb- MW-0 oqm <br /> COMMENTS ,+ <br /> REPORTING LUTE, TPH gm (50 pWL). BTEX (03 41.) <br /> Rely wished ig tui 1 d (S gnatyre) Dat f Relinquished by (Signature) Date Received by (Signature) Date <br /> Corm o$1raII Hd imempanyC Time Company Time Company Time <br /> i <br /> Storage/Disposal of Samples Sample will be stored at CKY for 30 days at no charge and at$10/sample/month thereafter Disposal of sample by the Laboratory will be charged at$10/sample <br /> f <br />