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> M� p i �1lXQ!72180,'H'0Wu,,on, <br /> NImg.S.!!� <br /> LIM0 Chesa sake Dr � <br /> tililllliiiiiiiii <br /> edwood City CA 94063 P 0 Box TX 77002-7426 qlol <br /> (415)364-9600 - FAX(415)364-9233 CHAIN 0F CUSTODY [l <br /> Consultant's Name Fp,, Page of I <br /> Address 3 $ -{-_ � � � - 100 I Site Location, )� <br /> Project# Consultant Project 5150151 30 Consultant Work Release# Wo <br /> Project Contact ePhone# 51 D ;R3-1 011 Laboratory Work Release# <br /> EXXON Contact M, 1Q� Phone # <br /> Sia 2�& -�7��0 EXXON RAS# ~I _ 013`1 <br /> U <br /> Sampled by(print), }� t3dnicl� 0 Sampler's Signature <br /> Shipment Method 52 00 19, Air Bill # 0a <br /> TAT- ❑ 24 hr ❑ 48 hr ❑ 72 hr ❑ 96 hr Standard (10 day) ANALYSIS REQUIRED <br /> Sample Collection Collection Matrix # of Sequoia's TPH/Gas TPW S M H Temperature <br /> Description Date Time Soil/Water/Air PrSv Cont Sample# BTEX/ Deese! <br /> 8015/ EPA 5520 Inbound Seal Yes No <br /> 8020 8015 Outbound Seal Yes No <br /> O <br /> 1 r, 131 an k -- — W l x <br /> 3 <br /> �I IW3P SanK 14/1 9`1 CP,3 0 W <br /> Mw t9 0 a 5 S >- <br /> NtW <br /> 10 to t•1 X <br /> D 30 <br /> 0 <br /> w ' 1l 10 X m <br /> N <br /> 17 <br /> t <br /> MW 5 ' —4 111 W8 <br /> RELINQUISHED BY/AFFILIATION Date Time ACCEPTED/AFFILIATION Date Time AddltlonalComments <br /> CA j-1 z /0.1 b y <br /> 00 <br /> Pfq\-101ATOK l Z�] <br />