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Aqua Terra Technologies 2950 Buskirk Avenue,Suite 120 <br /> Consulting Engincers&Scientists Walnut Creek, CA 94596 <br /> 415 934-4884 A T <br /> T <br /> ,�C��H��AIN OF SAMPLE CUSTODY RECORD <br /> Collector: -:9e—an•e- Date Sampled: /011.71,Flr 5:0.0 A"n <br /> Location of Sampling: ;rt. y <br /> CA <br /> Project Number: G� V Survey Number: <br /> Sample Type: Mv� er <br /> Container Type and Condition:_ 5;/0" <br /> Contract LaboratoryRecord x -� <br /> /Name:_- irleo�-rho .4s��Jt}res P.0 CA _ ..... .... � ; <br /> Sample 1D Field Information <br /> /�IGcJ/ av-- �/Or►+/ f/O.0 Q 1 <br /> r <br /> E <br /> Analysis Requested: <br />� T <br />{ <br /> Results Needed By: oN <br /> Contact and results to be serat 7tao• A c� � 117 <br /> Travel Blank: E7 Yes `T No Travel Blank to be Analyzed Separately: Yes No <br /> Duplicate Samples: ZSF Yes No Duplicates to be Analyzed Separately: D Yes No <br /> r Cleaning Blank: Yes Z�7 No Cleaning Blank to be Analyzed Separately: �1 Yes No <br /> Background Background Soil Sample <br /> ' to be <br /> Soil Sample: Yes �] No Analyzed Separately: Yes No <br /> I <br /> Chain of <br /> /o /3 I <br /> fiiel nnel Date <br /> 2. <br /> 3. �tl -C_ �t/l. !lOM1 Date <br /> Lab <br /> Date- <br />