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�w w ww w w w ■w ■w w w ww w w■ ■w �w w ww w w <br /> ley&Aldrtch,lnc Aft <br /> Phone { 6-7400 <br /> •, = 465 Medford St, CHAIN OF CUSTODY RECORD Fax 617 886-7600 <br /> Suite 22Q0, Page i of <br /> AWBoston,MA 02129-1400 <br /> H&A FILE NO 29625-000 LABORATORY TEG- Mobile Lab DELIVERY DATE <br /> PROJECT NAMF Penny Newman Grain Elevator Stockton CA ADDRESS TURNAROUND TIME <br /> H&A CONTACT J Weidmann/S Serrature/J Miller CONTACT PROJECT MANAGER Weidmann <br /> Analysis Requested <br /> Comments <br /> Sample No Date Time Depth N Numberof (special instructions,precaution <br /> s), <br /> additional method <br /> Containers numbers,etc <br /> Type u'Lio <br /> -1 - 10 y-5 Oa 5 Rlo Salt- 2 ► � <br /> 1 0900 135-15 -Solt- 2 � <br /> �'1 - 1 0 9-5 e 0110 165 ZO D71Sd�t- °'� z '�� <br /> \01:11335-3550,L, z H�� <br /> Sampled and Relinquished by Received by LIQUID Sampling Comments <br /> � � VOA Vial <br /> Sign%✓// 07 A f sign-1,1�1r�� - — -�_ —___ <br /> Print Print u — <br /> f, LL � � c1AVW..� 't� lhSf `� i_ - -- Y-- Amber Glass - - <br /> � � / P <br /> �,�""" Plastic Bottle <br /> Firm U..II kc1�i � . Flrrti i LO - - __ r - <br /> Date �N C Tmre �O� Date 4-5-O Time Prcsmanve v <br /> _.y. _ � -r---+ Volume <br /> Relmgmshed by Received by <br /> Sign Sign SOLID _ — -- <br /> E f i VOA Vial <br /> Print Print - <br /> ._ q <br /> Amber Glass <br /> Firm Firm _ _ r - � - - - <br /> r Clear Glass <br /> Date Time Date Time <br /> Relinquished by Received by !� _ r Preservative Evidence samples were tampered with' YES NO <br /> Sign Sign f Volume 1 r YES,please explain in section below <br /> Print Print PRESERVATION KEY <br /> Finn Firm A Sample chilled C NaOH E H SO, G Methanol <br /> Date Time Date Time B Sample filtered D HNO3 F HCL H Sodium Bisulfate <br /> Presumptive Certainty Data Packaee(Laboratory to use applicable DEP CAM methods) <br /> If Presumptive Cerlamty Data Package is needed,initial all sections Required Reporting Limits and Data Quality <br /> The required numntum field QC samples as designated in BWSC CAM V❑have been or will be collected as appropriate to meet the requirements of Presumptive Cerlatgty Objectives <br /> Matrix Spike(M S)samples for MCP Metals and/or Cyanide are included and identified herein ❑ RC-S 1 ❑ sl © G W I <br /> This Chain of Custodv Record(specify) includes does not include samples defined as Drinking Water Samples ❑ RC S2 Q S2 El G W2 <br /> If this Chain of Custody Record identifies samples defined as Drinking Water Samples Trip Blanks and Field Duplicates are included and identified and analysis of TICS are required ❑ RC G W 1 ❑ S3 ❑ G W3 <br /> as appropriate Laboratory should(specify if applicable) analyze hold for contingency testing the Drinking Water Field Duplicate and Drinking Water Trip Blank ❑ RC G W2 <br /> samples <br /> WHITE Laboratory CANARY Projcct Manager PINK Halev&Aldnch Laboratory GOLDENROD Haley&Aldnch Contact AUGUST 2003 <br /> Foran 3001 <br />