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URS CORPORATION Chain Of Custody Record <br /> 2870 Gateway Oaks Drive, Suite 300 Page of <br /> Sacramento, CA 95833 !J�l l�2 <br /> `J <br /> (916)679-2000 (916)679-2900 FAX tom" l <br /> Project Number: Site Name: - Analytical Methods:List number of containers,preservative per method <br /> I <br /> &000-L <br /> �,( n p A !! /�n (e.g.for sample of 3 VOA vials with HCI,record 3,A in box) <br /> - 1 VlA�2 5 � �t'f F'V lT `�T�� {'7/TSF ay <br /> 0 <br /> Sampler's si atur <br /> m 4LI, <br /> 4 ' i 0 <br /> Date Time Matrix Grab Comp Q <br /> Sample Number Sample Location Depth (MM/DD/YY) (24 Hour) SACODE MET C-i Remarks <br /> 9-I_Zv Z o 3-S-�S Jc�s s s X J` <br /> 6' ►-Zs ZS 3-s-�f3 (-700 5o X - <br /> ,y-�,c7 3p 3-s-v3 /7d5- x <br /> x <br /> /YqS Gw X <br /> Matrix Types:A-Air;GS-Soil Gas:GE-Gaseous Effluent;P-Product;S-Soil/SedimentlSolid;T-Tissue;W-Water. K Preservation:A-HCL; B HNO C-H2SO4; <br /> WG-Groundwater; W -Waste Water;O-Other(specify) D-NaOH; E IC , F -(speci <br /> W fy <br /> W IMET: G-Grab: TO-Tedlar AC-Summa <br /> RELI U SHED BY:(s cNATURE) DATE TTIIIMEE RECEIVED BY:(SIGNATURE) �^/��U�! RELINQUISHED BY.(SIGNATURE) DATE TIME RECEIVED BY:(SIGNATURE) <br /> RELINQUISHED BY:(SIGNATURE) DATE TIME RECEIVED BY LABORATORY: DATE TIME LAB Name and LAB Contact: <br /> (SIGNATURE) <br /> Remarks: ,: `COOLER ID: SEND RESULTS TO: <br /> FAX Preliminary results: (916)679-2900 <br /> White-Original to Accompany Samples Yellow- URS Main Office Pink-URS Fief Office No. <br /> s <br />