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OD � � <br /> M Chain of Custody Record <br /> Facility Name: DVI -sire Time: o '6+' Tem : 6 2 <br /> Site Name' Bum Pn ai4 Time' 2 0 T.P. <br /> Sky Conditions s�n n <br /> for California RESD State or Lead Regulatory Agency: RRaCB-Csobavalsyaeaian eto vological Evems: <br /> Requested Due Date(mm/dd/yy): ind 5 Dor"non: <br /> Lab Name:Cures and Tom kips,Ltd Facility Address: ConsWtanUContmctor. URS- Address:2323 Fifth Street dress: 2870 Gatewa Oaks Drive Suite 300 <br /> Berk) ,l u 94710 Sim ornia : Sacramento CA 95833 <br /> Lab PM:Mike Dahl 00 ifamiaect No: No.: SL205363007 nsolta°b'Contractor Pro'«t No.: 17326382.07000 <br /> ele/fax:510.486.0900/ s Project No.: N/A Comm tmUContractor PM: Vernon Elaah <br /> RESD Contact Sit.Desi ation: DVI-Bun Pit T.1,JFw 916.679.2000/916.679.2900 <br /> ddress'. has./WBS: mantaria welh <br /> RelLon Type&QC Level: Level 2 with EDF <br /> Sub Phasefrask: Anal iud mail EDD To: Marcie Redmond urac0 .mm <br /> ele/Faz: ink Code: 07000 <br /> Invoice m: URS <br /> Lab Bottk Order No: Matrix #nataioersw/preservative Requested Analysis <br /> 2 " <br /> r <br /> Y <br /> Item u 9 <br /> No. Sample Description F C Laboramry No. g e Sample Paint Let/Long sad <br /> o J In Commenb <br /> _ p `o <br /> a o u c2 2 <br /> 3 $ o 0 <br /> 0 2 a C 5 > e a 0 0 'c <br /> 1 MW-2-BP o05 ` x 3 iff <br /> x 3xVoas <br /> 2 MW-2-BP �m x 3 3 <br /> z x x z 1x250m1,2x500m1 <br /> 3 MW-2-BP DOS x 1 1 x 1x250nd ass <br /> / 4 MW-5-BP I° x 3 x 3xVoas <br /> 5 MW-5-Bp A x 3 3 x x x z - Ix25Dm1,2x500m1 <br /> 6 MW-S-BP D//j° z 1 l x 1x250m1 glass <br /> 3 7 MW-&BP 3 3 x 3xVoas <br /> 8 MW-&BP 3 3 x x x z Ix250m1,2x500mt <br /> 9 MW-6-BP 1 I <br /> x Iz250m1 glass <br /> `{ to (S-05-o2 / o7bo 5 3 <br /> Sampler's Nems aµ�g Nu Iteringaukede I Date O Acce a /atmiaeaa nae rme <br /> S tees Com URS 7 <br /> Shi ment Date: / <br /> Shi mrn[Method: Ltart. <br /> Shi ment Tmckin No: <br /> S eclat Instructions: Anions itr <br /> CN�— --- - — and nate;Dissolved:barium,arsenic,imR ,,gaom - <br /> Dissolved Metals:Filter&Preserve at Lab! <br /> W CUSIDdY Seals In Place Yes No Tcmp Blank Yes No Cooler Temperature on Receipt of/C Trip Blank Yes No <br /> O <br /> 1 <br /> v <br />