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Work Authorizatlo '0 21331-00 2133 Chain of Custody Pae of <br /> ARCO FacdtlYCliy,State(Facility) Project Manager(consultant) Project No (Consultant) Labillpy Name <br /> 02133 STOCKTON, CA Steve Misner 5064-04 Sequoia��le tical <br /> ARCO Engineer ARCO Telephone No Telephone No (Consultant) Fax No (Consultant) <br /> �' "— <br /> Su le Paul 510 299-8891 916-444 0123 916-856-5277 <br /> Consultant Company Consultant Address Method of Shipment <br /> Brown and Caldwell 9616 Micron Avenue,Suite 600,Sacramento,Ca 95827 <br /> Matrix Prsv <br /> Special Doleclion <br /> LImIUReporling <br /> e1 <br /> LU E a <br /> 1- <br /> Q m en m m <br /> o d) to 1° r L m z m <br /> Z S O �' m as 1 c <br /> 0 ro <br /> _ L �= 9 E <br /> m <br /> v E o z <br /> U °e' _' ,� ~ <br /> cn <br /> E a 4 a <br /> cn Z to to a <br /> BHD-1 3 X X r/19111 /Ps- x o 10 <br /> E-3 3 X X /yYs- X 10 Sub'd COC Attch'd <br /> E-4 3 X X 15zD X 10 <br /> E-9 3 X X r yos X <br /> Lo E-10 Il>;c � 3 X X �f7 47 f.S�,,s� X <br /> r <br /> O <br /> Y <br /> Q <br /> w <br /> Sample Received Intact Yes No Temperature received Ice No ice <br /> Rellnt Name) Date Time Received by(Sign&Pnnt Name) <br /> q ter I &Pr <br /> f #uL g1111 q? 5-5- Lab work No <br /> ReWnqulshed by Date Time Received by <br /> Relinquished by Date Time RIFialved by laboratory D Ti <br /> Rev 11129195 <br />