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Chain of Custody Record q/ls Iage�or <br /> URS <br /> Facility Name: DVI -site Time: Tem : <br /> Site Name: Bum Pit >i site Time: Temp: <br /> Sky Conditions: <br /> for Califomia CDCR State or Lead Regulatory Agency: RWOCB Meteorological Events. <br /> Requested Due Date(mm/dd/yy): Standard TAT Wind S Direction: <br /> Lab Name:Curtis and Tom Iti Ltd Facili Address: Cowultant/Conlrnctor: URS <br /> Address:2323 Fifth Strep dress: 2870 Gateway Oaks Drive,Suite 300 <br /> Berkley,CA 94710 Site Lat/lon WA Sacramento,CA 95833 <br /> Lab PM:Mike Dahl uist California Global ID No.: SL205363007 naWbnt/Com acsor Project No.: 17327022 <br /> ele/Fax:510.486.0900 Enlos Project No.: N/A onsulbnt/Contractor PM: Marcie Redmond x 12239 <br /> OCR Conbct: Site Designation DVI-Burn Pit ele/Fax: 916.6792000/916.679.2900 <br /> Address: Phase1WBS: motivirring vre1D rt Type k QC Level: Level3 with EDF <br /> ub Phese?arit: Anal 'cal mail EDD To: Marcie.redmond urs.com <br /> Tele/Fax: ask Code: 20000 nvoice to: URS <br /> lab Bottle Order No: Matrix ocont.1mr,w/preservative Requested Analysis <br /> Z <br /> Y <br /> 9 <br /> Item V Sample Point LaNlong and <br /> hn. <br /> Sample Description I Qa Laboratory No. i pp O Commeeb <br /> 0 3 <br /> R c � O <br /> yy V <br /> o U U v <br /> $ u <br /> c bt o a m S D O <br /> H y a g <br /> � r <br /> v°i 3 ¢ <br /> iz <br /> 1 MW-5-BP ¢ x 3 3 x 3-40ml vows,HCL <br /> 2 MW-5-BP x 1 I x x x x 1-1 liter rm reservalive <br /> 3 MW-5-BP x I 1 x1-250m1 H2SO4 <br /> 4 MW-5-BP x 1 1 x 1-500m1-no reservmive <br /> 5 MW-5-BP / x 3 3 x 3-40ml vows-no prescrvativc <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Sampler's Name: Relingvished By/Alfinsotoq Dste ime Ac pted ay/ARilintivn Date Tme <br /> Sam leh Com an <br /> Shi men[Date: <br /> Shi meet Method: 1, <br /> Shipment Tracking No: <br /> P <br /> Special Instructions: Anions(Chloride,sulfate and nitrate); Dismlved:arsenic,barium,cadmium,chromium,copper,iron,lead, <br /> man mese,magnesium,mercury,mol bdcrnum nickel,selenium,silica Dissolved Metals:Filter&Preserve at Lab! <br />"s <br /> Custody Seals In Place Yes No Temp Blank Yes No Cooler Temperature on Receipt of/C Trip Blank Yes No <br /> Ism = � M M M = M M = M � = M M M M M <br />