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= M = err = r r r r W W ■r M �r rr rr r rr rr <br /> naley&Aldrich,lne Phone (6W6 7400 <br /> a � , 465 Medford St, CHAIN OF CUSTODY RECORD Fax fill 8$6-7600 <br /> Siete 2200, <br /> of <br /> Boston,MA 02129-1400 Page 3 <br /> H&A FILE NO 29626-000 LABORATORY TEG- Mobile Lab DELIVERY DATE -(� t5'( <br /> PROJECT NAME Penny Newman Grain Elevator Stockton CA ADDRESS TURNAROUND TIME <br /> H&A CONTACT 1 Weidmann 1 S Serratore/3 Miller CONTACT PROJECT MANAGER Wetdmann <br /> Analysts Requested <br /> c C Comments <br /> Sample Na Date Time Depth Type _ C _ _ „ _ = Number of (special instructions preeaubons,additional method <br /> r a-., j Contrtners numbers,etc) <br /> a Zx U om i v, d� c F Ci <br /> m <br /> PA/ unlewelfter 163C5 <br /> Sampled and Re[RquishV by Received by LIQUID Sampling Comments <br /> Sign Sign VOA Vial a - <br /> PrinAll 4 Print HeVW�� IlistvtSC'- s Amber Glass <br /> � ,y,� Plastic Bottle <br /> Firm I/� C Firm /�Cr _ _ - <br /> Date r Time Date"l` Time - w _ Prtservanve m <br /> _ �Voltune <br /> Relinquished by Received by <br /> Sign Sign SOLID <br /> Print Print <br /> Amber Glass <br /> Firm Firm <br /> ClcarGlass <br /> Date Time Date Time Y _ <br /> Relinquished by Received by - -m T ___ Preservative Evidence samples were tampered with' YES NO <br /> _{ <br /> Sign Sign I Volume If YES,please explain in section below <br /> Print Print PRESERVATION KEY <br /> Firm Fimr A Sample chilled C NaOH E H,SO, G Methanol <br /> Date Time Date Time JB Sample filtered D HNO, F HCL H Sodium Bssulfate <br /> Presumnuve Certamty Data Packaee(Laboratory to use annheable DEP CAM methods) <br /> If Presumptive Certainty Data Package is needed initial all sections Required Reporting Limits and Data Quality <br /> The regmred minimum field QC samples as designated in BWSC CAM Vi)have been or will be collected as appropriate to meet the requirements of Presumptive Certainty Objectives <br /> Matnx Spike(MS)samples for MCP Metals and/or Cyanide are included and identified herein ❑ RC Sl S] ❑ GW t <br /> This Chain of Custody Record(specify) includes does nm include samples defined as Drinking Water Samples C3 RC S2 S2 C1 G W 2 <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 ofTlCs are required ❑ RC(;W1 ❑ S3 El GW 3 <br /> as appropriate Laboratory should(specify if applicable) analyze hold for contingency testing the Drinking Water Field Duplicate and Drinking Water Trip Blank d RC GW2 <br /> samples <br /> WHITE Laboratory CANARY Project Manager PINK Haley&Aldnch Laborawn GOLDENROD Haley&Aldrich Contact AUGUST 2003 <br /> Form 3003 <br />