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Chain of Custody Record Pagey of G <br /> URS <br /> Facility Name: DVI [ky <br /> e Time: Tem <br /> Site Name: Burn Pi[ te Time: Temp: <br /> oMitions: <br /> for California CDCR State or Lead Regulatory Agency: RNOCB rological Events: <br /> Requested Due Date(mm/dd/yy): Standard TAT S Direction: <br /> F <br /> :Cums and Tom Id Ltd FacilityAddress: onsultam/Contracor. URS <br /> 323 Fifth Street ddress: 2870 Gate Oaks Drive Suite 300 <br /> Bmkl ,CA 94710 Sire L VLon . N/A Sacramento,CA 95833 <br /> ike Dahl uist alifomia Global lD No.: SL205363007 Comultant/Conuactor Projeot No.: 17327022 <br /> 10.496.0900/ fos Project No.: N/A ConsultantlContractor PM Mamie Redmond x 12239 <br /> ntact: ite Desi tion: DVI-Burn PB e1e/Fex: 916.679.2000/916.679.2900 <br /> hase(WBS: montoring wells nT & Level: Level3with EDF <br /> Sub Phasefrask: Analytical -mail EDD To: MarCie.redmond9turs.corn <br /> ele/Fax: ask Code: 20000 Invoice to URS <br /> Lab Bartle Order No: Matrix sooatainersw/preservative Requested Analysis <br /> 2 <br /> It. Sample Description LbratNo. c o- oVF <br /> Sampe Poirot Lat/L <br /> ong and <br /> 6 No. Comments <br /> c t <br /> 4 C 9 U U � 9 <br /> 9 P O O U O�a .Cm.. ♦". O <br /> G Y 4 u O P (] O G <br /> o Is <br /> 5 0 m i-- '� S a <br /> h 3 ¢ 5 2 S X e <br /> 1 -7-BP 141/0 x 3 3 x 3.40m1 vows HCL <br /> 2 [W-7-BP x 1 1 x x x x 1.l liter,no veservffiive <br /> 3 MW-7-BP z I 1 x 1-250ml H2SO4 <br /> 4 MW-7-BP x I I x 1-500mi-no preservative <br /> 5 MW-7-BP - x 3 3 x <br /> 3-4liml vows-no preservative <br /> b <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Sampler's Name: 4 I LRrn <br /> rpuishetlB Date I Time ccepted ey/ARliatbn to I Time <br /> Sam lets Company URS <br /> Shipment Date: 4Mq±I <br /> ® - <br /> Shi mens Method: 4.R,11'i1. <br /> Shi mens Tracking No: <br /> S ecial Instructions: AnionsChloride,sulfate and nitrate); Dissolved:mmnic,barium,cadmium,Chromium,copper,iron,lead, <br /> manganese,magnesium,mercu ,mol bdemum nickel,selenium silica Dissolved Metals:Filter&Preserve at Lab! <br /> r. <br /> CustodX Seals In Place Yes No Temp Blank Yes No Cooler Tempemture on Receipt_oF/C Trip Blank Yes No <br />