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URSGrelner Chain Of Custody Record ��bi�� <br /> 2520 Venture Oaks Drive, Suite 250 <br /> of <br /> Sacramento,CA 95633 Page <br /> (9 16)929-2346 (916)929-7263 FAX <br /> Project Number: Site Name: Analytical Methods:List number of containers,preservative per method <br /> (e.g.for sample of 3 VOA vials with HCl,retard 3,A in box) <br /> 1-03 ��- 0Ck4- �y �� p <br /> Sampler's signatures: h�m �a <br /> v <br /> Date Time Matrix Grab Comp r NZ <br /> Sample Number Sample Location (MM/DD/YY) (24 Hour) SACODE MET �� Q Remarks <br /> 06-20'-00 (00'0 S N 1 X I S I e-Y e- <br /> I;-w 2-_67-6 13- L 06-Zo-do 1400 V/otis <br /> S'Q3- 2 SS!3 3 46-21-00 v 83S )C - S 1 e tc e <br /> 503-- .610 tr, p cl p !g-- fie u-.e <br /> Cw3 -S� O`ilS wC <br /> Z5- x 1 -Slav <br /> 5 94 -50 <br /> q-t6 oIt 3s NI <br /> O�-M I �0 7 n--ei-,x, I l -,or✓ ' <br /> Matrix Types:A-Alr,GS-Soil Gas;GE-Gaseous Effluent;P-Product;S-Soll/SedirnentlSoild;T-Tissue;w-Water, Preservation:A-HCL;B-HNO3; C-H2SO4; D-NaOH; E-Ice; F-(specify) <br /> WG-Groundwater; 0-Other(specify) <br /> M Grab: ar• A <br /> RELINQUISHED BY:(siGNATURE) DATE TIME RECEIVED BY:(SIGNATURE) RELINQUISHED BY:(SIGNATURE) DATE TIME RECEIVED BY:(SIGNATURE) <br /> RELINQUISHED BY:(stGNATURe) DATE TIM IRECEIVED BY LA130RATORY: DATE TIME LAB Name and LAB Contact:C V 0-oS f TCI ih P <br /> (sIONATURE) z3 fD�[S EtA-Uy Vi'lie <br /> SEND RESULTS TO: O <br /> Remarks: COOLER ID: P k/( Co X <br /> C 1e FAX Preliminary results:(916)929-7263 <br /> VVhite-Original to Accompany Samples Yellow- URSG Main Office Pink-URSG Field Office N o. 5024 <br />