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nvironmental 9083 Gold Cana!Drive 3 I� <br /> Laboratories- Rancho Cordova ( EE SIDE 2 I-OR <br /> 11"11 CA 95670 r� COMPLE7F_ <br /> Phone 916/652 6600 CHAIN OF CUSTODY RECORD U 3 212 INS7RUCl'ION.S <br /> w K Fax 916/852-7292 <br /> Ship To: Project Name* i �{�f r� FOR LABORATORY USE ONLY Analytical Common <br /> G 41.11 <br /> Address Project Number: Laboratory Projelt# � / 4132 Long Method <br /> Storage Refrigerator ID / _ Y 413 2 Short Method <br /> `.—�J' 4181 long Method <br /> / <br /> Project Lo ation: (State) r Storage Freezer ID 4181 Short Method <br /> Sampler Name 4201 <br /> P / lure PPE Worn m Field 5022 <br /> 5031 <br /> helm 524 2 <br /> . vim )_ Date/lime Received By r Meth of 1pment/SM merit I D Datel ime 601 <br /> 3 16•/3 6-1 ' 602 <br /> Relinquished By Date/timeReceived By or Method of Shi t/Shipm I D Datefrune 604 <br /> 608 <br /> 610 <br /> Relinquished By Dateffirne eceiv By or Method of Sh in Shlpre t I D Datelrune 624 <br /> U UAB 625 <br /> � S 8010 <br /> 8015 <br /> Sample DisposalLevel 1 E]2 ❑3 EJ a E]5 ❑6A ANA YSES REQUESTED 8015o Mod <br /> of <br /> (check one) QC <br /> (see Side 2) F]6B ❑6C ❑6D ❑ E]6E 7 Write in Oao <br /> LAnalysts Method 8060 <br /> Laboratory Standard <br /> Blau <br /> 8150 <br /> ❑ Other <br /> SAMPLE INFORMATION 8240 <br /> 8270 <br /> 6310 <br /> Description Container <br /> Acidity <br /> (s)LABORATORY USF ONIY Sample ID P (s) ti Alkalinity <br /> lab ID Number Date Time Locator De th Matrix Pres 0 1chloride <br /> 3TEX <br /> (� n P # Type 'T•y'pe Type TAT �` CLP (see Side 2) <br /> I COD <br /> !f T I✓i '� � W fi f Color <br /> 2 Conductivity <br /> Corrosarrty <br /> 3 Cyanide <br /> Flashpoint <br /> Fluoride <br /> 4 -- <br /> 5 General MrneraY <br /> bGHar Chriarmum <br /> G t i/ Ion Balance <br /> f� [ Metals(write spectla <br /> 6 I metal 5 melhod a) <br /> Metals 6010 4 <br /> 7 7JT+ Melals PP <br /> z ! 7� Metals Title 22 <br /> 8 TTLC Levet <br /> STLC Level <br /> 9 Nrttal�Sde 2) <br /> Nitrite <br /> 10 Ode 1 <br /> Qrg Lead <br /> l7rg Mercury <br /> Special[nstructions/Cntnments Pistclmolure <br /> Container Types A=I Liter Amber Time)(Analytical Turn Around mme) Peroent Sd',sd <br /> 13=13rass Tube C=Cassette 1 =24 hours 2=48 hours Perchlorate <br /> G=Glass Jar P=Polyethylene 3=I week 4=2 weeks pH <br /> phos hates <br /> O=Other V=Voa Vial 0=Other Phosph« us <br /> Suliale <br /> Su tides <br /> FOR LABORATORY USE ONLY Sample Condition Upon Receipt SEND DOCUMENTATION AND RESULTS TO(Check o TCLYOA <br /> Project Manager/Office Semivoa <br /> Metals <br /> ❑ Client NameTris Pesticide <br /> Tolai Hardness <br /> Company TolW Solids <br /> TPWD <br /> Address TTSS <br /> Turbidity <br /> Phone FAX Speorly Total or Dissolved <br />