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110 Pacific Gas 62-1174(Rev 2199) <br /> and Electric Gnvironmenta3 affairs <br /> Company r DOq <br /> Chain of Custody Record <br /> From: Pacific Gas&Electric Company ❑PG&E Facility ® Sample Site Sltip To: Lab Name:Castle Analytical <br /> Address or Location: Z S/7 d9W41 e12S 11 CJt Address: 2333 Shuttle Dr <br /> City: [ <br /> —(7 pJ City:Atwater CA (!ip)4 305 <br /> Contact NalnetPhone No.: Phone No. <br /> -- Contact Name: - <br /> Turnaround Time Analysis Requested <br /> [:]NORMAL(10 days or less) ®RUSH Specify <br /> ❑TELEPHONE ❑FAX Give Results to:Wavne Pacheco(M I&p e.com) <br /> Project Nam vice Ceoter Project Supervisor(Name/Phone No,): <br /> Sampled by: (Signature) (Print Name) C/ <br /> Samolc No./ Sampled Containers <br /> E uipment Serial No. Date Time Sample Type/Description No. Size Remarks <br /> ..... <br /> _ a.._ _._._ --- <br /> 47..5.* <br /> _........._ _._... _..—._...._.._ <br /> 1 Q, <br /> 12. <br /> ll <br /> 13. —�......_ _._... _..... <br /> ....... <br /> ... .._..__.._.. <br /> .............._ _ - .._._........e__._................ <br /> ... <br /> . _......... <br /> ... <br /> _._.. ...._......... <br /> .......__.._--.-------- <br /> .._.-..._.---------- ...---....--- <br /> _. _...__.W._....._....__......................... ._...............__................................_.__.............................__._... .._..__.._.........---___-._........_...._..... <br /> ......... <br /> ........ <br /> . . _...—_......_.... __........_.__.._._......_......._.._...._._.. ._.. .,...... _....... _ _ <br /> 14. <br /> I �l q" hed b,(N 6 J� V-113 Date& iir': Received by(Namc&Dept.C&LQ D tc&,rime: Ship Via: p <br /> Reimuis db / -C /viaY,X � a�-10 P <br /> q y(Name&Dept.): Date&Time: Received by(Named:DcpQ. ate rme: Bill ofUding/Airbill No.: <br /> Relinquished by(Name&Dept.) Datc&Time: Received by(Name&Dept-): Date&-Time: <br /> SAI'Accounting Data: Billing CL)ntact: Billing Address: <br />