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ieV&Aldrich,lnc Phone (6W6-7400 <br /> Fax 617 886-7600 <br /> • i 465 Medford St, <br /> ite 220D, "CO"CHAIN OF CUSTODY <br /> Su <br /> Boston,MA 02129-1400 Page of <br /> H&A FiLE NO 29626-000 LABORATORY TEG- Mobile Lab DELI VERY DATE O <br /> PROJECT NAME Penny Newman Grain Elevator Stockton CA ADDRESS TURNAROUND TIME <br /> H&A CONTACT 1 Wei dmann/S Senatore 1 J Miller CONTACT PROJECT MANAGER Weidmann <br /> Analysis Requested <br /> Comments <br /> Number of (special instructions,precautions additional method <br /> Sample No Date Time Depth Type <br /> E - Containers numbers,Me) <br /> a V a <br /> 125..E F 5-10 SJIL- <br /> 15c5, 135-D5 ,SoL <br /> 1310 1&55 <br /> 1330 2 5�0 ,5+1_.. <br /> 133 33535 <br /> LIQUID Sampling Comments <br /> Sampled and Relinquished by Received by <br /> ` i VOA Vial <br /> Sign ,Q St - - <br /> ' ( i- Amber Glass <br /> Print.,. � � I r[ Print 1' �1N.,�t <br /> U --- - v r iV�_ --- -- - <br /> "� Plastic Bottle <br /> Firm <br /> Finn �` ,�Y1�� sC _ _ - I - <br /> rC 1-� -t - <br /> Date Tone Date A-S-C)tj Time 1315Preservanve - - - <br /> Relmqutshed by Received by -^ - -- T*- _ Volume - - <br /> SOLID <br /> Sign Sign -- <br /> 'VOA Via! <br /> Print Pnnt —T I_ -- <br /> -- <br /> -Amber Glass <br /> Firm Firm <br /> ' �Clrar Glass <br /> Date Time Date Time <br /> Relinquished by Received by - - - f Preservanve Evidence samples were tampered with' YES NO <br /> Sign Sign volume If YES,please explain in section below <br /> Print Print PRESERVATION KEY <br /> Firm Finn A Sample chilled C NaOH E H SO4 C Methanol <br /> Date Time Date Time B Sample fiitered D HNO, F HCL H Sodium Bisulfate <br /> Presumptive Certainty Data Package(Laboratory to use aooltcabie DEP CAM methods)If Presumphve Certainty Data Package is needed,initial all sections Required Reporting Limits and Data Quality <br /> The required mimmum field QC samples as designated in BWSC CAM Vli have been or wdl,be collected as appropriate to meet the requirements of Presumptive Certainty Objectives <br /> Matrix Spike(MS)samples for MCP Metals and/or Cyanide are included and identified herein 0 RC Sl 0 Sl Cl G W l <br /> This Chain of Custody Record(specify) Includes does not include samples defined as Drinking Water Samples 0 RC S2 1:1 S2 L1 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 0 S3 Q G W3 <br /> as appropnate Laboratory should(specify iF appl[cabie) analyze hold For contingency testmg the Drinking Water Field Duplicate and Drinking Water Trip Blank ❑ RC GW2 <br /> samples <br /> WHITE Laboratory CANARY Project Mai;J er PINK Haley&Aldrich Laboramy GOLDENROD Haley&AldnchContact AUGUST 2003 <br /> Form 3007 <br />