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I A MACTEC ' <br /> CHAIN OF CUSTODY RECORD 3857 <br /> MACTEC Engineering and Consulting, Inc. SAMPLING <br /> 5341 Old Redwood Highway,Suite 300 NAME OF FACILITY: <br /> Petaluma,CA 94954 INFORMATION �t <br /> (707)793-3800•FAX(707)793-3900 STREET ADDRESS: *- F�i�rsfjll/ h s� Tri Y t <br /> � U a� CITY/STATE: �T�����C GJ ZIP: <br /> PROJECT NAME JOB NO. <br /> SAMPLERS(S NATUR SAMPLERS INITIALS(PRINT), Q D= �5 <br /> z Z <br /> SAMPLING DATE <br /> iL J <br /> 0 O <br /> ow ,, �.< <br /> m a: • SAMPLE SAMPLE FIELD I.- <br /> TIME 9 MATRIX NO. LOCATION MEASUREMENT vr.z• <br /> Sy <br /> 6 x X/� I MEN--"- <br /> 1 1 f ti'4 <br /> XY./ / ♦ /\ !\ <br /> W <br /> 3� <br /> Mo x I V �3 <br /> gpv4t <br /> ?y� a J1= <br /> r <br /> RELI DISHED BY: QATE/TIME RECEIVED BY: DATE!TIME �RELINQUISHERBY: REC 1 D BY: DATE/TIME <br /> '1�4(SI ATURE) (SIGNATURE) v (SI TURF) �+ <br /> 2 r•+ t17*MATRfX b 0lK 3v <br /> 4 DISTRIBUTION:ORIGINAL AND YELLOW COPIES A OMPANY SAMPLE SHIPMENT TO LABORATORY. <br /> 1 1 PINK COPY RETAINED BY SAMPLERS. YELLOW COPIES RETAINED BY LABORATORY. <br /> 1. WATER-W �' REMARKS <br /> OIL 1 SEDIMENT-SO <br /> ER-NA — cLj if �UC�f/t✓ <br /> ;.,,. e t S a"P,.r' n s a. to n,i y�yy }- j' r >; s �,}1- '71rlt::=`�'j'L f ! v �;; +'�. t- •+,5 <br /> i <br /> dd Seals � ehfn' No ra #cjtl SSfa ?;Yds ` No N� pct�d$yw - J_t , t <br /> J <br />