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� <br /> G <br /> � ��3 ou3 <br /> ENVIRONMENTAL �'10 Lowell-Larimer Road �4�/ <br /> /nduatrial Hyalene and Ev«en,wa. �2os <br /> (206)399-1002 <br /> Environmenta/ Coensultants fax: (433)383-8849 <br /> CHAIN OF CUSTODY SAMPLE LOG <br /> Client Our Savior's Lutheran C6urch Location 4 2 F reet 9rive � <br /> Projoct Barn ' <br /> Inspector Thea Ewin¢ Phone Number 52061399-1002 _ � <br /> Number� n�i es Fan Number (4251365-8849 _ <br /> , <br /> I F�f�__1,C61 T1�RN�ROLINB TLYF k, k nti1 <br /> ❑ PCM(airJ ❑ PeirR Chips❑Air <br /> �PLM(bu/k)❑ Sa! ❑ TCLP ❑ 1 hour ❑ 2�hours <br /> Other_p DusfAvlpe �3 to 5 deys <br /> ❑ I hours ❑48 hours <br /> Scq.k Leb ID S�mpk# A/R Seq.H La61D Sampk M A/R <br /> � �S - C 4 <br /> 2 . �5�/— l�� � - <br /> 3 5 —/ D � �/��C <br /> � _, ., <br /> s �s <br /> 6 16 <br /> 7 l7 <br /> 8 18 <br /> 9 19 <br /> ]0 20 <br /> DATE T[ME <br /> �a�Br• 2/ /10 <br /> Relinquished BY� 2/ 4 /10 <br /> DELIVERED BY: 2/ 24 /10 <br /> Received By: ' <br /> AnalycedBy: '- �a Z%� <br /> RuWts called in by: � <br /> Ruulu faxed by: <br /> SPECIAL INSTRUCTIONS: Pleue Emzil rnpy of C.O.C.wkh reanita, <br /> Khameronaol.com <br />