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Ad&M 40 > W m - <br /> --rr� rte_ �� --� •--� -�, ..�� .-�—. r-...a.... � .-�..r-, .��, .--w .�.-.�., C '"'"'�' <br /> ..�vl. ..V14�, 1V T v.�7.h. H + <br /> 680 Chesapeake Or �'► � <br /> rood Cily CA 94063 N1 P O Box 2180,Hous TX 77002-7426 <br /> (415)364 9600 • FAX(415)364 9233 h CHAIN OF CUSTODY <br /> Consultant's Name Page of <br /> AddressL4(,f t v Site Location 41q- /tri r�h� <br /> Project# Consultant Protect It C�1:5 -3c,-f L12 l o U Consultant Work Release # <br /> Prated Contact C �,r�s� Phone# S �r _7 Laboratory Work Release# <br /> c <br /> EXXON Contact a� <br /> f1"+(.��� [� -,S Phone # �S-. 2( -�- EXXON RAS # 2- <br /> Sampled <br /> Sampled by(print) (�A(zL 5 C�{.6r-5(�LaN Sampler's Signature <br /> Shipment Method 5C ups A Air 8111 # <br /> TAT ❑ 24 hr ❑ 48 hr ❑ 72 hr ❑ 96 hr Standard (10 day) q g 0.�7,,C o ANALYSIS REQUIRED <br /> ct 5 � <br /> Sample Collection Collection I Matrix #of Sequoia's TPH/Gas TPH/ TRPH f,-t,,7Prsv BTEX/ Diesel S M Tamporalure <br /> Description Date Time 5od/Water/Air Cont Sample# <br /> p 8015/ EPA 5520 �'rW Inbound Seal Yes No <br /> 8020 8015 Outbound Seal Yes No N <br /> 7 �C: O <br /> V3 l005� j Zo o <br /> 13 <br /> U Vt3-lin <br /> P,13(cc, 7z/0 h -7 i <br /> f o` <br /> D <br /> 0- <br /> RELINQUISHED <br /> RELINQUISHED BY/AFFILIATION Date Time ACCEPTED/AFFILIATION Date Time Additional Comments <br />