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Department of Toxic Substances Control <br />Environmental Chemistry Lab - Berkeley <br />700 Heinz Ave. Suite 150, Berkeley CA 94710 <br />Phone: (510) 540-3111 Email smoff@dsc.ca.gov <br />Sample Transport Record Sheet <br />Authorization # :�+ <br />Site Name: eAZC Lkcr� �ro�Ic!�}}ller �I�t <br />Site Address:yll $�C�x K e[•d <br />Silo C LA. f CA 1 SZ <br />i <br />Records included: ARF SAR <br />Sample Receipt Sheet <br />ECL No. Collector 1D. Sample Type Analysis Request Remark (see note) <br />c <br />EP -0-44A L �f„JL<-Vs 4 s ,7- �xc <br />Note: for remarks: OSC - Original Sample Container; SS - Split Sample; A - Aliquot; F - Fractionated Sainpie <br />Reteased_for Transport by: <br />Name: i�✓` 'tGY4 i�x: Si }raEur� � �-�'�i . _ DateMine: �12r: 7 4 d 3 AMft< <br />Tracking Number. '414 2 (] 4 -f Q Lj S' (F �j Confmaatiou Number: -:SF—M4 6' <br />Narne of Laboratory Sample(s) Transported to: 14T -L Location (city): s7z'!,t-. H,, I i <br />Transported by: (circle one) 6—/ r Other If other, specify: <br />Reminder: Include copy of transport bill in authorization folder. <br />Canunents and/or Additional Tracking Multiple Packing Shipment (MPS) $: <br />DCN: 07.0072.00_ Revision 3_09117l2020_Approved by Quality Management Officer <br />Page 1 of 1 <br />Page 10 of 26 <br />