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EMO OMPANY, USA. 1 :-:2D ANALYSIS REQUEST OTHER <br /> AIN OF CUSTODY RECORD NO Page f ofd_ <br /> Exxon Engineer Dann Rouse Phone (925)246-8768 (CHECK APPROPRIATE BOX) <br /> Consultant Co Name ETIC Contact Chris Chatburn ° C3 0 v <br /> Address _ 744 Mayhew Way Phone (925)977-7914 ❑ o x 0 <br /> C3 Z <br /> Walnut Creek CA 94596 Fax (9251977-7915 ° o CI a 0 <br /> 0 n O co -1 z <br /> Q m id } FV- <br /> / o a O z ❑ ❑ <br /> RAS# 7-3942 Facility/State ID#(TN Only) o z g ° m a a N❑ <br /> AFE#(Terminal Only) Consultant Project# 0 ° ° a w 7 <br /> N (7 y <br /> co <br /> Location 4444 N Pershing Ave (City) Stockton (State) CA < ❑ `° N Q ° <br /> 1:1 EE El CBM 0 SDT z w ❑ ❑o CI d © a <br /> Q 0 G p Q N U <br /> Consultant Work Release# 19909830 BTS# /�UG� <br /> O w o � O � m ❑ m oo � b � ❑ ❑ <br /> Sampled B Blaine Tech Services, Inc 1 Print Name © ��-,��i 0 z N am V J T W ° z <br /> p Y w ¢ N S e C7 N O 4 4 j J ~ a W <br /> MATRIX ° z uxa M C7 bd = -J 2 d m <br /> SAMPLE i D DATE TIME COMP GRAB H2O SOIL AIR OTHER PRESERVATIVE z 0 m Q � O 0 h z 0 LU L O it N <br /> yt/.y 12 �5L/a X fC 3 X }( CA <br /> Jgz <br /> �rw-5 lyin <br /> ^ � Urso <br /> /1 U1-1 1415 <br /> /2w-2 I2,N7 <br /> t/ 14/ 15z3 <br /> 133 <br /> Mw•-7 J s / <br /> TAT SPECIAL DETECTION LIMITS(Specify) REMARKS <br /> 24 HR 72 HR EXXON UST <br /> 48 HR 96 HR CONTRACT NO <br /> Standard X •Contact US Prior S02317MOl SPECIAL REPORTING REQUIREMENTS(Specify) LAB USE ONLY LOT# Storage Locatlon <br /> Other to Sending Sample ��� <br /> QA/QC Level --// J <br /> Standard © CLP ❑ Other❑ FAX Eli�FAX C-O-C W!REPORT WORK ORDER# f LAB WORK RELEASE# <br /> Relinquishe pier Dat Time Received By <br /> CUSTODY Relinquished B 5 pier Date Time Received By <br /> RECORDRelinquished By Sampler Date Time Receive 'Laboratory <br /> 2 ( G <br /> Wa Bdl ' ler Tem <br /> SHIP SAMPLES BACK TO SPL INCORPORATED, 8880 Interchange Drive Houston TX 77054 Ph (713)660-0901 Fax (713)660-8975 Ph 400-969-6775 <br />