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, CHAIN OF CUSTODY <br />QUARTERLY- <br />Client <br />UARTERLY <br />Client : City of Stockton, John Fukumoto, P.E. <br />TEST <br />DESCRIPTIONS <br />_ See <br />reverse <br />side <br />for <br />Container, <br />Preservative <br />and Sampling <br />information <br />1 <br />Address: Public Works Department, Solid Waste Div <br />— J <br />City Hatt, 425 North El Dorado Street <br />Stockton CA 95202-1997 <br />o <br />v > <br />C <br />Phone : (209)937-8829 <br />N <br />z <br />- <br />Fax (209)937-8277 <br />ZnF— <br />O <br />c <br />ti <br />V <br />O <br />- — 3-11207 <br />fe <br />u, <br />Ui <br />=G <br />Fes- <br />U <br />ct~ <br />v, <br />F- <br />1 <br />aoi <br />cn <br />— <br />Project Name : Austin Road Monitoring MW -13 <br />Contact person : John Fukumoto, P.E. <br />w <br />N <br />t� <br />ai a 1 <br />•� <br />�- <br />Purchase order Number: <br />ca <br />w <br />Z <br />z <br />z <br />a <br />m <br />o <br />o <br />a <br />Z <br />QA/QC report required: Yes No <br />U <br />v <br />H <br />F- <br />o <br />,v <br />m `" <br />ur <br />z z <br />J <br />0 <br />Q <br />41O <br />U <br />v <br />°® <br />��C <br />Z <br />s e <br />U a <br />v <br />U <br />m <br />n. <br />Sampler(s): <br />u. <br />a <br />aT� F- <br />w t— <br />N <br />S <br />vii <br />li = N <br />0 <br />Comp sampler setup Date:—/—/— Time: <br />C <br />0 <br />•O N <br />u. <br />- <br />0 <br />z `) <br />N <br />?_ <br />N O <br />co <br />� <br />z <br />N <br />— <br />Rush Results due By: <br />m <br />z <br />� a <br />_ <br />° a <br />g <br />(TT <br />m <br />_,> <br />a g <br />a <br />a <br />—/—/— <br />:- <br />z a <br />0. - <br />a s <br />Received: <br />° <br />1 N <br />°o <br />�Date <br />--— <br />,0 <br />,0d <br />v o <br />Co <br />� <br />do <br />�i <br />ab <br />NN_ <br />. <br />EdN-131/ <br />Number:533 <br />v <br />r- <br />.o .9. <br />�1 <br />:U <br />11Lab <br />X:O <br />,0 <br />O <br />O <br />a <br />n. <br />OU <br />O <br />U <br />N a <br />°OOU <br /><U <br />C 11 <br />O <br />� U <br />N <br />O <br />U U <br />U 0 0 <br />m U U <br />41 <br />UO <br />v U <br />O <br />tY <br />W <br />Samp <br />Location/Description <br />Date <br />Time <br />Num <br />Sampled <br />IL <br />°/U <br />Q.)w <br />3 <br />0Sampled <br />_ <br />M <br />ti <br />1 <br />MW -13 Field Parameters <br />%�ae i'S. <br />®� �5. <br />G <br />MW <br />1 <br />1 <br />2 <br />MW -13 Monitoring Parameters <br />��! <br />ii <br />G <br />MW <br />2 <br />1,1 <br />3 <br />MW -13 Constituents of Concern <br />11 <br />(� <br />G <br />MW <br />4 <br />MW -13 Travel Blank <br />9I <br />G <br />LBW <br />1 <br />5 <br />MW -13 Field Blank <br />1� <br />if <br />G <br />LBW <br />1 <br />Misc. Notes: <br />Relinquished By: Date: Time: <br />J� -7AA, <br />Relinquished By-:r:Time: <br />at Relinquished By: Date: Time: <br />/ %f.'S�3 <br />t-�6i�%�,D �utp 7711211S !?JL <br />A <br />Final Sample Dispostion: <br />_ <br />A, <br />R ceived by: ate: Time: <br />_ <br />by: Date: Time: cei ed 'y: Date: Time: <br />Lab Disposal:—/—/— Returned to Client <br />Meth. of Disposal: Date Ret. / / <br />--- <br />C �,� ��g fC. �j� <br />�ceived <br />'������5' //= oCf�� <br />Ili <br />Corporate Offices & Laboratory <br />!' �) P:)y ^; 2 0 ;3 Cntpuiatina Stmnt <br />Office and Laboratory <br />2,00 Sklo-coadl f io ]d <br />Field_Office <br />4h� di i. Cahhn:�, i <br />C. <br />11 <br />