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Phone (61'W-7400 :1 <br /> Haley &Aldrich Inc Fax 617 886-7600 <br /> 465 Medford St, CHAIN OF CUSTODY RECORD <br /> Susie 2200 Page t of <br /> Boston,MA 02129-1400 -+3 <br /> ?962b-000 LABORATORY TEC- Mobile Lab DELIVERY DATE <br /> H&A FILE NO TURNAROUND 71ME <br /> PROJECT NAME Penny Newman Grain Elevator Stockton CA ADDRESS <br /> PROJECT MANAGER Weidmann <br /> H&A CONTACT J Weidann I S Seiratore I J Miller <br /> CONTACT <br /> m <br /> Analysis Requested <br /> - Comments <br /> c n _ Numberof (special instructions preeauh0ns additional method <br /> Sample No Date Time Depth Tvpe o _ N ;a „ Containers numbers,etc) <br /> U 4 e C <br /> �y Qd d w ]LLtl u6w V F a-°U <br /> GpizO 9_10t 00-D ee <br /> 0230 14-15I -' P L <br /> ^Z` C) LlQU1D Sampling Comments <br /> Sampled and Retingwshed by 1 Received by <br /> I VOA Vial <br /> Sig( I Sign� t7 - Y - _ Amber Glass <br /> Print �- M f` Print��' �►'"y 1t1 t��a`�iOv _ -3 plastic Bottle - <br /> FirmtG�'� Ftrm"MC - _ - - -- s -- - - - <br /> �, Prerrvanve <br /> Date Time Cd Date +C--04 Time <br /> �rzs+ti - E Volume <br /> Relinquished&Y Received by ( j_ <br /> SOLID <br /> Print <br /> Sign ri i6lr+r'ial �/ v m <br /> Print Print _ __ - <br /> Amber Glass <br /> Firm Firm <br /> Clcaz Glass <br /> Date Time Date Time _ i <br /> f1`LS 'Preservative Evidence samples were tampered with YES NO <br /> Relinquished by Received by <br /> /volume If YES please explain in section below <br /> Sign Sign <br /> PRESERVATION KEY <br /> Print Print <br /> A Sample chilled C NaOH E H SO4 G Methanol <br /> Print Firm <br /> H Sodium Bisulfate <br /> Date Time Date Time B Sample filtered D HNO, F HCL <br /> Presumptive Certamly Data Packaee(Lahoratory to use annhcable DEP CAM methods) Required Reporting Limits and Data Quality <br /> If PresumpUse Certainty Data Package is needed initial all sections Objectives <br /> The required nurnmunt field QC samples as designated in 9WSC CAM V11 have been or will be collected as appropriate to nice(the requirements of presumptive Certainty Q RC Sl 1:1 S I GW I <br /> Matrix Spike(MS)samples for MCP Metals and/or Cvamde are included and identified herein El RC S2 ❑ S2 Q G W2 <br /> This Chain of Custody Record(specify) includes does not include samples defined as Dnnkmg Water Samples <br /> 1f this Chain of Custody Record identifies samples defined as Dnnkmg Water Samples Trip Blanks and Field Duplicates are included and identified and analysis of TICS are required RC G W 1 S3 GW 3 <br /> as appropriate Laboratory should(specify if applicable) analyte hold for contingency testing the Dnnkmg Water Field Duplicate and Drinking Water Trip Blank E3 RC GW2 <br /> samples <br /> AUGUST 2063 <br /> WHITE Laboratory CANARY Project Manaber PINK Halev&Aldrich Laboratory GOLDENROD Haley&Aldrich Contac( <br />