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KI FF O Davi 2nd Street Suite 300 <br /> Davis,CA 95618 Z <br /> Lab: 530.297.4800 SRG#/Lab No. Page of Z <br /> AnalyLlCal LLC Fax: 530.297.4802 <br /> Project Contact(Hardcopy or PDF To): Caltiomia EDF Report? E Yes ❑No Chain-of-Custody Record and Analysis Request <br /> Paul Anderson Cell# 618 406-0823 <br /> Company/Address: PSC Environmental Services Sampling Company Log Code: Analysis RegU¢St TAT <br /> 210 West Sand Bank Road,Columbia,IL 62236 P$CI o — ❑ <br /> PhonFax#: Global ID: T0607700653 < 12 hr <br /> e#: T <br /> (618)281-1543 (618) 281-7020 3 a <br /> W ❑ o <br /> Project#: P.O.#: EDF Deliverable To(Email Address): m Y m <br /> 62403335-024522 <br /> panderson@pscnow.com <br /> o o i A w 2a hr <br /> "' m S a o n N 7 <br /> Project Name: Sampler Signature: m m m m w o _ >' <br /> Sara Lee-Lincoln Street(Well Installations) Marshall Lake,Paul Anderson a '" °0 a a a L1W N W W WJ a m W C <br /> Project Address; SamplingContainer Preservative Matrix F 48hr ti <br /> ' wSrm- °2rA <br /> cmi<8 rJ3 1444 South Lincoln Street, wJrG <br /> DJx <br /> QElNStockton, CA 95206 Q m ? p• o 72 <br /> h <br /> r <br /> ae <br /> OW <br /> W wO ° O Z oW mw 1 wk <br /> Sample M z 0 ¢ > > <br /> Designat Date Time v N a n <br /> I CT-VAW- -0-0 Gt- III 6/21109 64S 2 x x x x x x x X <br /> rJ r�Lw. >Z C x x x x x x X <br /> e 6 ll 1092 ( x X X X X X X X X <br /> I t-Mlrs-4 Ow l(t0 6136109 (636 Z l X x x x x x x x X 0 <br /> 111 .1 - 006C x x x x x x X <br /> kk� t <br /> _NSW$ �^ u N <br /> 6 <br /> / /09 0 f x x x x x x x x X <br /> D X X X X X X X X <br /> X X X X X X X X <br /> -:41 <br /> x x x x xxx X - + - X X X X X X o X <br /> Relinquished by: Time Received by: Remarks: V o f N1.l} — <br /> 6 CoCiKtY1 b 1/2`t <br /> 301 <br /> ^^ Diesel and Motor Oil are with Silica Gel Cleanup. <br /> 1?7 Y I "Always sample fro vial with least amount of s diment. <br /> Reli ished by: Date Time Received by: he su,�,y (r f Vt9� Ail f.� '4 W We", <br /> EN 2.G7-ccl O <br /> Bill to: PSC Industrial Services,LP,210 West Sand Bank Rd,Columia,IL <br /> Relinquished by: Date Time Re ed b La ratory: (//^ For Lab Use Only: Sample Receipt <br /> Temp°C nilDate Time ThemD colnt r•se3ooq t-3/-, Yes / No <br /> Distribution: White Lab;Copy-Originator <br /> Rev. 051805 <br />