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Chain of tod Record �S l_ Pag ofM <br /> URS <br /> Facility Name: DVI -site Time: Temp: <br /> Site Name: Bum Ptt f--site Time: Temp <br /> Sky Conditions: <br /> for California CDCR State or Lead Regulatory Agency: RwaCBMeteorological Events: <br /> Requested Due Date(mm/dd/yy): Standard TAT ind S end: DirectionLab .- <br /> Name:Curtis and Tompkins,Ltd FacilAddress: Comulnnt/Conimctor URS <br /> Address:2323 Fifth Street <br /> Berkley,CA 94710 ire LauLon N/A <br /> Address: 2870 Gatewa Oaks Drive Suite 300 <br /> : <br /> b PM:Mike DahSacramentoCA 95833l uist lifomia Global ID No.: SL205363007 Consultant/Contractor Pmj=t No.: 17327022 <br /> Tele/Fax:SI0.486.090D/ Enfos Project No.: WA Comultant/Coff,,Mr PM: Marcie Redmond x 12239 <br /> R Canna: Site Desi alit, DVI-Ban Pit ele/Fex: 916.679.2000/916.679.2900 <br /> Address: hawAVBS: montorio welt' Re T & Level: Level with EDF <br /> Sub Phaserask: Anal cal mai1EDDTw Marcie.redmoncIUrs.com <br /> Tele/Fax: ask Code: 20000 nvoiceto: URS <br /> Lab Bottle Order No: Matrix Meonnine"W/preservative Requested Analysis <br /> t <br /> Item <br /> Simple Description S e. <br /> Na. P P (— 9 Laboratory No. � E � Sample Point hat/Long and <br /> 9 Comments <br /> 3 8 <br /> V 9 a O O X <br /> 9 � a y O �? S m •C � O <br /> VOf UY A � <br /> 6 0 = O <br /> 1 MW-24-BP ,S x 3 3 x <br /> 3-40m1 vows,HCL <br /> 2 MW-24-BP x I 1 x x x x 1-I liter,no reservative <br /> 3 MW-24-BP x I l x <br /> 7 I-250m1 H2SO4 <br /> 4 MW-24-BP x I I x 1-500ml-no preservative <br /> 5 MW-24-BP x 3 3 x 3-40m1 vows-no preservative <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Sampler's Name: 411t(L 4L is vie y/Atnn.Oaa Date =Ti-. <br /> opted By/Affiliation net <br /> Time <br /> Sampler's Company: ITR da <br /> Shipment Date: <br /> Shipment Method: NRn <br /> Shi meet IMckin NO: <br /> Special Instructions: Anions(Chi ride,sulfate and nitrate; Dissotwd:arseniey barium,cadmium chromium mplaer,iron,lead. <br /> J <br /> manganese,magRe ium,mercury,mol bdemum nickel seleni silica Dissolved Metals:Filter&Preserve at Lab! <br /> Custody Seals In Place Yes No Temp Blank Yes No Cooler Tem o <br /> Temperature on Receipt_ F/C Tri Blank Yes No <br /> 3) <br />