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U4655 <br /> ldnch,Inc Phone (6 7400 <br /> ord St, CHAIN OF CUSTODY RECORDFax 517 886-7640 <br /> ,A 02129-1400 Page of 3 <br /> R&ARFNO <br /> 24626-000 LABORATORY TEG- Mobile Lab DELIVERY DATE r' <br /> PROJECT NAME Penny Newman Grain Elevator Stockton CA ADDRESS TURNAROUND TIME <br /> H&A CONTACT J Weidmann/S Serratore!J Miller CONTACT PROJECT MANAGER Weidmann <br /> Analysis Requested <br /> Comments <br /> Sample Na Date Time Depth Type r = s ' _ ° a = Number or (special instructions precautions additional method <br /> Conuiners numbers etc) <br /> a <br /> 07 ¢a as ? v.V ww'U ttbU <br /> i <br /> �q -z 35 ��I°�I +� 35�t ��►� <br /> .�- �5 'A��1°`l <br /> z'� W k <br /> _ __Z-51 11�A5 � <br /> 6 0 2:3 1E- <br /> Sampled and Re ingmshed by Received by LI UID Sampling Comments <br /> VOA Val <br /> Sr 6 t�--,++e� - ;- <br /> ! _ Amber 0m <br /> Si gn E.^ l _ <br /> Print 1 `i 1l Print N��+ W It iAs Oso- _ - - - - <br /> Plastic Mtdc <br /> Firm <{,�Y� �VCV-,, ST rC . Ftmt lk'Va - - - - - <br /> Preservative <br /> Date L4- -U Time fL- Date t{'(i-Q�f Time - <br /> 'Volume <br /> Rehnquashed by Received by <br /> SOLID <br /> Sign Sign <br /> Print Print -- - - - - - e1'F <br /> Amber Glass <br /> Firm Firm _ <br /> Clear Glass <br /> Date Time Date Time - -- <br /> - — Preservative Evidence samples were tampered with" YES NO <br /> Relinquished by Received by <br /> i 'Volume If YES,please explain in section below <br /> Sign Sign <br /> PRESERVATION KEY <br /> Print Print <br /> Firm Firm A Sample chilled C NaOH E H SO4 G Methanol <br /> Date Time Date Time B San>ple filtered D HNO, F HCl. H Sodium Bisulfate <br /> Presump4ve Certamtv Data Package(Laboratory to use applicable DEP CAM methods) <br /> Required Reporting Limits and Data Quality <br /> If Presumptive Certainty Data Package is needed,initial 211 sections <br /> The required t unimutn field QC samplesRC <br /> as designated in BWSC CAM V11 have been or will be collected as appropriate to meet the requirements of Presumptive Cenainty Objectives <br /> Matnx Spike(MS)Samples for MCP Metals and/or Cyanide are included and identified herein ❑ RC S1 ❑ :31 ❑ G W I <br /> This Chain of Custody Record(specify) includes does not include sanTles defined as Drinking Water Samples C1 RC G ❑ S2 E? G W2 <br /> ❑ <br /> If this Chain of Custody Record identifies samples defined as Drinking Water Samples Tnp Blanks and Field Duplicates are included and identified and analysis ofT1Cs are required C1 RC G W 1 ❑ 53 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 Project Manager PINK Haley&Aldrich Laboratory GOLDENROD Haley&Aldnch Contact AUGUST 2003 <br />