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FORM IC <br />i"Ose-" <br />GeoRestoration, Inc. s"�JA-1 10- 1622 <br />CHAIN OF CUSTODY FORM <br />Maw L.:ne (406) 2�2-8450 <br />Pacs'rnife: (408) 295-8451 <br />Turnaround <br />_..'Qday 3 day Sar-ne aay <br />ptojet 'Nallie li-t' <br />Time: <br />7 day 2 day <br />Project Nurnbe, c- j--'j;j Tasic <br />(working 0ays) <br />5 Ilay I day <br />Global 1.11: <br />Project -Address: <br />Labwatory, W-Campb4-11 Anaiyf i,-af Contact Ro-sa <br />Analyses Requested <br />Lab Address/Phone 1535 Willow Pass Road, Pittsbur_q, CA (V7) 252-9262 <br />Project Manager:r t'A <br />PM Prione Number� <br />bi , - T cc:'Aj'o. Email- Corn <br />San pler411! Phone E408 292-8�150 <br />'k-'-'Zj 4!' <br />Sampie Information Container Information <br />--- ----------------- <br />Comments <br />Matrix <br />TV Preservative <br />F€P.ld Paint Name <br />Me <br />rs' pe <br />same as GRl Sample <br />Sample ID Date I Time <br />lc <br />r <br />--t-f <br />-T---- ... . .... .... <br />— <br />— <br />--------------- <br />T- <br />. .... . .......... <br />AaaMor-i' Comments Invotoe to ocnREstoi.auor. snc and $end report tc. rnaing gecirestoialor- corr <br />. .... . <br />Geotracker ED-F <br />A_A_DatelTirne <br />Receued SyL V'J, 6�X't- <br />Date"-Firne i 1'71yr- <br />gwirquished By batemnie -7' <br />�k 10 <br />- Receivm By <br />Date-JITo'ne <br />Relinquished By DatefTime <br />Received By <br />DaWTinne <br />Gor'd, Yes— Ni ReIrvefated -, Yes — No — oo'.p <br />Page <br />-1ht <br />Conlia�n" Typc V - 4D L t 0ar4l' indfR,. ^00 W - '5(0 millito.-F booft-, = hk* fEl t),ass S - <br />steof, P -A"A Preservatwe t4'71.. ar.j d 4o <br />A;, J'W A %. <br />FORM IC <br />