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i 4 <br /> CHAIN OF CUSTODY 971,229 <br /> ,eftC710 AJ <br /> SAMPLER TOSCO ANALYSES REQUESTED <br /> S/S # 5-y2-1 CITY:SAC J'%{;�r� TURN AROUND TIME: <br /> WITNESSING AGENCY ADDRESS:' -7.54.3 P,2 C <br /> SAMPLING �T V "��� <br /> SAMPLE M NO. DATE TIME WATER GRAB COMP NO,OF CONT. LOCATION REMARKS <br /> X k u• X �( 7#10s exYe,e-A14r�s <br /> ti11<l Z K lo:s—� <br /> 41 LID 7X ?1 GS <br /> T a r vv A ���� X X X 121 D29 <br /> RELINQUISHED BY: DATE/TIME RECEIVED BY: DATEITIME THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES: <br /> /4/10�9} i� i, HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br />` (SIGN TUR (SIGNATURE) -, 4 <br /> - 2. WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> G,-7 12 --! <br /> (SIGNATURE) ! <br /> (SIG ?URE) !1'Q 3. DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> j 7 <br /> (SIGNATURE) (SIGNATURE) 4. WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED?. <br /> (SIGNATURE) {SIGNATURE/ SIGNATUR TITLE: DATE: <br /> Lt-s4 .(r } c> i S 4 1Z[(c h <br /> ..Note: All water containers to be sampled for TPHG/BTEX, 8010 & 8240 are preserved with HCL. All water containers to he sampled for Lead or Metals are preserved with HNO3.. All other containers are <br /> unpreserved. <br />