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Chain of Custody Record Page-�of <br /> URS <br /> Facility Name: Bu On-sitz Time: Tem <br /> Site Name: Bum Pit Ofi site lime: Temp: <br /> Sky Conditions: <br /> for California CDCR State or Lead Regulatory Agency: BwOCe eteomlogical Events- <br /> Requested Due Date(mm/dd/yy): Standard TAT Wind Speed Direction: <br /> b Name:Curtis and Tompkins,Ltd Facility Address: onsultanVConnactor URS <br /> dress:2323 Fifth Street Address: 2870 Gateway Oaks Drive,Suite 300 <br /> Berkley.CA 94710 3itc LaV Wn : N/A Sacramrnto,CA 95833 <br /> PM:Mike Dahl uist 7ahlornia Global m No.: SL205363007 omultnnt/Contractor Project No.: 17327022 <br /> ele,Vax:510.456.09D0/ os Pmjem No.: N/A onsultam/Contractor PM: Marcie Redmond x 12239 <br /> Contact: Site Designation: DVI-Burn PitTele/Fax: 916.679.2000 1916.679.2900 <br /> dress: hme/WBS: montoring wells Rcport Type 8 QC Level: Level with EDF <br /> Sub Phaserrask: Anal cal -maiIEDDTo: Marciexedmond urs.com <br /> ele/Faz: Irfask Code: 20000 Invoice to: URS <br /> lab Bonk Order No: Metria q containers w/preservative Requated Analysis <br /> 2 <br /> Item v U <br /> Na Sample Description C 4boratory Na E Semple Point Iat/Lang and <br /> o e O Comments <br /> 12 O <br /> 9 9 V V y <br /> v 0 <br /> N d 4 V J P O O C C <br /> I MW-25-BP oz� yfj/p x 3 13 1 1 1x 340m1 vows HCL <br /> 2 MW-25-BP x I 1 x x x x 1-1 liter,no preservative <br /> rG 3 MW-25-8P x 1 1 x I-250m1 H2SO4 <br /> 4 MW-25-BP x I I x 1-500ml-no lmservative <br /> 5 MW-25-BP x 3 3 x 340ml vows-no P17MCNalive <br /> 6 <br /> 7 <br /> ILL 11 <br /> 8 <br /> 9 <br /> 10 <br /> Sampler's Name: ANv/ b(I Min 110.. Time ccepted ay/ARlindon Dre Time <br /> Sam lers Com any: U p, <br /> Shi mens,Date: <br /> Shipment Method- - <br /> Shi ment Tmckin No. <br /> S ecialInslructions: Anions Chloride, fate and nitrate); Dissolved:arsenic,barium,cadmium,chromium, r,iron,lead, <br /> )D man attessul <br /> e,Magnesium,mere moil bdemum,nickel,selenium,silica. Dissolved Metals:Filter&Preserve at Lab! <br /> Cuslody Seals In Place Yes No Temp Blank Yes No Coolcr Temperature on Receipt of/C TriBlank Yes No <br />