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Emlor M M M M M M M I' M M � � M <br /> Ar <br /> Balch IVa " <br /> HYDRt <br /> ENV1R � MENTAL Chain ®f CustodyCA PO-20$9 <br /> TEC HN k OGIES, INC. . <br /> 2394 Mariner Square Drive, Suite 2, Alameda,CA 94501 Page 3 of 14 <br /> 510-521-2684 (voice) 510-521-5078 (fax) Date 7/ !3 12000 <br /> Lab Name TBG Analysis Request <br /> Address 11350 Monier Park Place <br /> m <br /> x � h <br /> Rancho Cordova, CA 95742 2 E <br /> cc CD <br /> bF p <br /> Telephone 916-853-8010 m <br /> X Q" a m v c ti �d n in Ntie in e 'L O <br /> Sam lets(&gnatur �, r a a F o o o ¢ u <br /> A0. u y m z U o0 000 ov a p a s <br /> Coda Do vii x r�i� cn n v o > <br /> Sample Number Matrix Location 0 0 „ ¢ r CC31 u a O -J z <br /> P F a m a F h- t- E- 7 7 > to d a cc. ,..! a< a <br /> 1 0007 3 SO soil B-3 ( t o feet) X X IX C <br /> z 0007 3L4 D soil B-3 0- feet) X X I I X i <br /> 3 0007 i 1'-t 2-3 soil B-3 { t D feet) <br /> 4 0007 3 4 5 soil B-3 { Z,5-feet) <br /> s 0007 soil B-3 (30 feet) <br /> e 0007 { 5 71'5 soil B-3 (6-)'feet) <br /> 7 0007 soil B-3 (f'L feet) <br /> s —899 COD <br /> ,) 1 0007 soil B-3 ( feet) <br /> l0 0007 soil B-3 { feet) <br /> Project Information Sample Receipt Relinquished By 1 Relinquished By 2 Relinquished By 3 <br /> Project Name Totel No of Cumamer. <br /> Central CA Traction Co u- 1 <br /> Project Manager Chain of Custody Sea], (Sig wre) (Time)(Sr at (Time)(Sigadture) (Time) <br /> Avakian GyNPtA(k f kjkl<r(nom al C3 t>— ra � 7,O,, <br /> Job No Rcc d Good Condman/Cold (Punted Name) (Date)(Printed Name) (Date)(Punted Namc) (I)ate <br /> 007-346 L�;�[� <br /> Shipping ID No Conforms to Record (Company) (Company) /' /I (Company) <br /> Lib No Received By 1 Received By 2 Received By (Laboratory) 3 <br /> I <br /> Hand aL <br /> Siiului lntitrtufiurrJ(urrtrn�rltti (%ignature) (runt)(Signature) (Time)(Signature) (Tune} <br /> r T1y) �1 &7 R W d 6 r <br /> (Printed yNit"ci (Dnle)(PnntcdName) � � (Date)(Printed ntNa"e) (Dm)Standard Turn Around Time <br /> (C umpmty) (Company) (Labomtary) <br />