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fllll� MBI ronmental 3083 Gold Canal Drive <br /> Labo,_ ,ries Rancho Cordova .Si.. I)L 2 /-OR <br /> P one 916/852-6600 CHAIN OF CUSTODY RECORD A 956700 0 0 6 IN.U'z�CIJ Ns <br /> Fax 916/852-7292 <br /> Ship To: h'Jr A C� "� Project Name' cv-A df FOR LARORATOR}'USE ONLY ytummnn <br /> �^� L�►/` Analytical Ntt•lhods <br /> l 3.1 <br /> 41 <br /> Address: &A 43 Project 03 0601zlir -003 Laboratory Project I� �,x 4132 Long Method <br /> 413 2 Short Method <br /> Storage Refrigerator ID: LA— 4 18 1 Long Method <br /> Project Location: (State) 418.I short Method Storage Freezer ID: 4201 <br /> Sampler Names g a— PPE in Field 50 <br /> 2.2 <br /> 503E3E <br /> �.,,� ,,. 503.1 <br /> o. 524 2 <br /> Relin uishcd f t Received of t I.D. D to Dime 601 <br /> `' �i�.,� 9`� / oS— / 7 Iy6 s f 602 <br /> 604 <br /> Relinquish Datefrlrne Received By or Method of Shipment/Shipment I.D. Date/fime 4 608 <br /> 610 <br /> RelinquishYd By: Datefrime Received By or Method of Shipment/Shipment I.D. Date/time 624 <br /> 625 <br /> 8010 <br /> 8015 <br /> Sample Disposal �-� ❑ ❑ ❑ ❑ ❑ ANALYSES REQUESTED 8015 Mod <br /> (check one) Level of QC 2 3 4 5 6A 8021 <br /> o/ 80i44t0 <br /> (sec Side 2) ❑6B ❑6C ❑6D ❑6E ❑7 Write in t 8080 <br /> 8100d Method Analysis Meoa <br /> Laboratory Standard Anal . Z 11150 <br /> ❑ Other SAMPLE INFORMATION .7 d 8270 <br /> 8310 <br /> Description , Acidity <br /> FOR LARORATORY USF,ONhY Container(s) r, 1 Alkalinity <br /> BTEX <br /> Lab ID Sample ID Matrix Pres. o '` \ ChlorideNumber Date Time Locator Depth # Type Type Type TAT Ct P (see SO.2) <br /> ■■ ` �]7�� ` / COD <br /> 1� 0� 301 1 tiY $ZD 6Color <br /> �7`/�I n -�l.f r Sty/I f�� 2- Conductivity <br /> 6/43 0Z J •'1 -- -- Corrosrv4y2 <br /> Cyanide <br /> — CIJ� '3J _ 7���/ x %hpoint <br /> 3 <br /> Fluoride <br /> General Mineral <br /> 4 - 013301 y J-2 Ar X Hex.Ch, <br /> omwm <br /> Ion Balance <br /> 5 Metals(—to specific <br /> metal 8 method x)' <br /> 6 Metals 60 0' <br /> Metals PP• <br /> 7 Metals Tele 22: <br /> TTLC Level <br /> 8 S TLC Level <br /> (see Side 2) <br /> 9 Nitrate <br /> _ Nitrite <br /> I Odor T-1 I <br /> Org.Lead <br /> Org.Mercury <br /> Special Instructions/Comments: �f 6 c e" Percent Mo.stare <br /> I� Container Types: A=I Liter Amber TAT(Analytical Artrund 'me) Peroent Solid <br /> B=Brass Tube C=Cassette I =24 hours 48 hou Perchlorate <br /> eth lone 3=I week weeks <br /> Y Y P <br /> G=Glass Jar P=PoInospnates <br /> O--Other V=Voa Vial 0=Other Phosphorus <br /> Sbate <br /> o Ides <br /> SEND DOCUMENTATION AND SULTS TO TCLP: <br /> FOR LABORATORY USE ONLY Sample Condition Upon Receipt �E (Check one): VOA <br /> j �roject Manager/Office: ( /�•- �J /�� Ma;s <br /> ElClient Name: TDs Pesticide <br /> Total Hardness <br /> Company: Total solids <br /> TPWD <br /> Address: Tss G <br /> Turbidity <br /> Phone: FAX: __ sp—ly r„,f .,o,.-A—d <br />