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..me + =/ <br /> rafo <br /> nmental 3083 Gold Canal Drive ` J/�� <br /> La5 Rancho Cordova ;, 7SCCraetrP2!OR <br /> CA 95674CHAIN-4F CUSTODY RECORD 032111 INCOMPLEFE <br /> Suomi= <br /> Phone 9161852-6600 <br /> Fax 916/852-7292 <br /> Common <br /> FOR LABORATORY USE ONLY <br /> Ship To: Protect Name: _ �� �'//r-� � Analytical Metfiod3 <br /> q <br /> 4131 <br /> Address- Protect Number: Laboratory Project# r 4 32L— Method <br /> T <br /> Storage Refrigerator ID q-370 T 4 18 1 Long Method .« <br /> Protect Location: (State Storage Freezer ID 4201 Short Method <br /> 5022 <br /> Sam ler Name , St urd WE Worn in Field <br /> ;`7 & Y 'f u / Vt.( 5242 <br /> Rel d rt _B D fi Received By or ethod of hipment/S ipment 1 D Dateffime 601 E <br /> /. 602 <br /> Relinquished By Date/I'ime Received By or Method of Shi ent/Sht nt I D Date/Tune 6608 <br /> 610 aim <br /> Relinquished By ate/I�ime �" Received By or a of Shipment/Shipment I D DatelTune 625 <br /> �Y �=SS i �.� i• 6" '- 3 U cl ►�t-. 8010 s <br /> L�� 8015 <br /> Sample Disposal YSES RE UESTED 8015 Mod <br /> p Level of QC 01 ❑2 ❑3 ❑4 ❑5 ❑6A am <br /> (check one} 8021 <br /> (ice Side 2) ❑6B ❑6C ❑6D ❑6E ❑7 Write m 8080 <br /> Laboratory Standard Analysts Method 81o0 <br /> 6150 <br /> E] OtherSAMPLE INFORMATION ' 8270 <br /> 8310 <br /> Descnptton Contamer(s) N Acidity <br /> FOR LABORATORY USF ONLY BTEX <br /> Ub[� Sample ID `� Matrix Pres Chloride <br /> Number Date Time Locaiorfy T Depth # TypeType Type TAT CLP (see Side 2) <br /> y CAD <br /> 1 �`�- d� _q74 Ar`7 �- i Color <br /> CCorrtductnrdy <br /> orroswity <br /> 2 CCyanide V I C Cy <br /> 3 / C Flashpoint <br /> O/ Fluoride <br /> General Mineral <br /> 4 / L Hex Chromium <br /> Ion Balance <br /> 5 b o / �� Metals Ivrrde specific <br /> metal&method ay► <br /> 6 6 v Mdals 6010 <br /> Metals PP <br /> 7 Z S �L„r� Metals Tale 22 <br /> l�/� TTLC Level <br /> g I G e STLC Level <br /> (see Side 2) <br /> 9 ` Nitrate <br /> Wide <br /> 14 C b I�'/ cr �+i O�rg rtead <br /> V'y Mercury <br /> Special Instructions/Comments Percent Moisture <br /> Pe Container Types A=1 Liter Amber TAT(Analytical Turn Around Time) Percent Solid <br /> B=Brass Tube C=Cassette 1 =24 hours 2=48 hours Perchlorate <br /> G--Glass Jar P=Polyethylene 3=1 week 4=2 weeks Phosphates <br /> O--Other V=Voa Vial 0=Other Phosphorus <br /> Suliate <br /> t ` Sulfides <br /> rr 5 t ��r�t SEND DOCUMENTATION AND��LTS� Che Ve) ,[G TCLP <br /> FO LABORATORY USC ONLY Sample Condition Upon Receipt j. �Ct} /I VOA <br /> El Project Manager/Office seMetals <br /> ❑ Client Name TDs Pesticide <br /> Total Hardness <br /> Company TPwDSoI ds <br /> TPHrG <br /> Address TSS <br /> Turbidly <br /> Phone FAX Specify Total or Dissolved <br />