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Dames & Moore, 1999 - USDA Forest Service

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Chain of Custody Record 5<br />

Parametrlx, Inc. . 6808 Lake Washington Blvd. . Klrkland, Washington - 98033-7380 . 2068224880 Fax 206-8894808<br />

ProJect Name: Fcl ( Project Number: w7.t 005-- O I 7 Client: h- o.c t . - LL.<br />

SamplerS: P c h?k , 3. &&m. P%~/n/g CBFUL) . 'j:. LA,& wdcr~~ ( C hcav ~ecorder: ?, %\k<br />

L<br />

Matrix<br />

# of Containers and<br />

Preservatives I<br />

Sample Number<br />

I<br />

Date<br />

Analysis Required<br />

0<br />

c<br />

z R<br />

2<br />

m<br />

Month Day Year Time<br />

y / STE-SED-161698 - I 10 lb 78 laha 6 r ~ ; n S~CC<br />

Y ( STE - s ED -ID~~SB<br />

- - - -<br />

-2 lb IL ~e 1~a3<br />

P& -SED -lblb98-3A 10 tb 78 1236<br />

y / SE-SED -rblb?8 -3 LO 16 98<br />

-,,-<br />

Y I s LO rL 98 rzq?<br />

/ 10 16 48 1258<br />

Chain of Custody Record (Please Print)<br />

I I I I I 1<br />

Relinquished By: (Name) I Date: I Tlme: I Received By: (Name) I .- Date: I Time: I<br />

Whlta Copy: Laboratory - Yellow Copy: Return to Parametrlx lnc. . Plnk Copy: Pararnetrht lnc.<br />

-..-a

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