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LAB: <br /> ❑TA-Irvine,California Q SHELL Chain Of Custody Record <br /> ❑TA-MorganHill,California NAME OF PERSON TO BILL: Denis Brown INOIti NI (ESoNLYj` <br /> MTA-Sacramento,California Q -�ENVIRONMENTAL SERVICES ❑CHECK BOX TO VERIFY IF NO INCIDENT#APPLIES <br /> El TA•Nashville,Tennessee 9 13 9g rJ $ 7 4 DATE: J �� <br /> ❑ <br /> NETWORK DEV/FE ❑BILL CONSULTA <br /> CalsctenceNT p0# SAP or'QRMT# <br /> ❑Other ❑COMPLIANCE ❑RpTT/CRMT PAGE:�_ of <br /> SAMPLWG COMPANY: LOG CODE: SLTEADDRESS:Street and Cily slate GLOBALIDNO.: <br /> Blaine Tech Services 341 East Main Street, Ripon CA 70607700724 <br /> AVORESS: EDFOELIVERABLETO(NweCompanv.Otriee Location): PHONE NO.: E-MAIL: CONSULTANT PROJECT NO.: <br /> 1680 Rogers Avenue,San Jose,CA 95112 703(R� BZ( <br /> Fno.IECTCONTACT(H+rd apyaPDFRepwwy, Joe Neely,Cambria,Sonoma 707-933-2361 sc)nomiiedf@cambria-env.com <br /> Jason Brown SAMPLER NAME(S)(Rint): <br /> LA(B USE gNLY , <br /> TELEPHONE: FA%: ENTAIL: �G� <br /> 916.925-2913 x102 916-925-2891 rown blainetech.com j,�(,(yl �lf <br /> TAT(STD IS 10 BUSINESS DAYS/RUSH IS CALENDAR DAYS): [] RESULTS NEEDED <br /> 1�070 ❑ 5 DAY ❑ 3 DAY ❑ 2 DAY ❑ 24 HOURS ON WEEKEND REQUESTED ANALYSIS <br /> ❑ LA-RWQCB REPORT FORMAT ❑ UST AGENCY: ( I <br /> SPECIAL INSTRUCTIONS OR NOTES: ❑EDD NOT NEEDED FIELD NOTES: <br /> ❑SHELL CONTRACT RATE APPLIES o 0 m <br /> ❑STATE REIMS RATE APPLIESm v Container/Preservative <br /> ❑RECEIPT VERIFICATION REQUESTED v a <br /> w or PID Readings <br /> m a or Laboratory Notes <br /> rn m a m m <br /> San Joaquin County Reporting Limits IL w o m 00 0 0 (D m to m <br /> V' OI to <br /> to 0 <br /> m N Q to O <br /> 1 y C0 0 o c <br /> SAMPLING NO.OF x = x x m m ¢ w w 4 p TEMPERATURE ON RECEIPT CO <br /> enon <br /> p <br /> Field Sam fe IdtificatiMATRU( o 0 <br /> '9NlY DATE TIME CONT. F <br /> 31� 1 s?" W X ?� I X1 k <br /> 02 yt,tW Z <br /> 13, X IX ' <br /> a ;x Yi,,w 3 13`� x I A KI I <br /> Xylkd ,ti►w-s�� i2 k x X <br /> m v INO �C h <br /> rnw- (aA IK /y- <br /> 0 <br /> 16 <br /> 6W-1 y31`111L X1,16 <br /> Relinquished by:(Signalure) Received by:(Signature) Dale: 71me: `l <br /> �7zd <br /> -_- G <br /> r <br /> Relinquished by:(SIn lure) Received by:(SI pa a y Date: Time: o. <br /> 3 ya o� iso (7 <br /> Relinquished by'.(Signal Received :(Signa ) D e: Time: -a <br /> a <br /> 05/07/06 Revision <br />