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Pacific Gas 62-1174(Rev 2199) <br /> ' s i andE/ectric Environmental Affairs <br /> Company <br /> Chain of Custody Record <br /> From:; Pacific Gas&Electric Company [)�P`G'&'E Facility El Sample Site Ship To: Lab Name: Castle Analytical Laboratory <br /> Address or Location: Oakdale S/C—811 W.I St Address: 2333 Shuttle Dr(BLDG 908) <br /> City: Oakdale s CA (Zip)95361 City: Atwater .CA (Zip)95301 <br /> Contact Name/Phone No.: Jeff Rhinehart Phone No. (209)3 84-293 0 <br /> Contact Name: <br /> T o d Time Analysis Requested <br /> ❑NORMAL(10 days or less) 2RUSH ❑OTHER,Specify <br /> nueate rme L <br /> E]TELEPHONE E]FAX Give Results to:Jeff Rhinehart (209)576-6523 G� <br /> Project Name: Project Supervisor(Name/Phone No.): ////////Remarks <br /> �Dl 7 <br /> Sampled by: (Signature) C �� (Print Name)J Gff 4( 30 5 <br /> ISarn le Nod Sampled Containers <br /> Equipment Serial No. Dae Time Sample Type/Description No. Size <br /> 1. o� blab �i1 �:... .._ .: q� v <br /> 2. ....._ ...._._._....._____._... ___...r...�....._._...._.._....._......_._... ..._.............................. ...... ...... ....... _. —....... _.... _....................._............................................................_................... <br /> _......................._....._... .. ........... .... <br /> ......................... <br /> ............... <br /> ..........i ......... ...................................... ................_........................................_..................... ..............I............................. ...... ...... ..... ........_.... ...... ......... _......_ .................._.............._........................................................................................ <br /> 6. <br /> ...._........................... .......................................... ........._.......................................................__....... ...._........................................ .... ..... _...... ....... ....... ....... ....... ....... ............................................_..................................a........................ <br /> 8. ......_. _...._.......__..._..._.._.__... ........................................... ..........._.........................................................._ ._........................................ ......._ ..... ...... __..... ........_ ...... ..._... ....... ....................._.._..__..._..._._........__............................................... <br /> ..........................................................._..............................................................._. .._..._............................................._............................._........................................................................................................................................................................... <br /> 9. <br /> _ _......._....................._...._..... ........................... <br /> ................. <br /> .................. <br /> ..._ .._.........._............................_._ ....._._............_._............_........_...._...................._._._.._........_......... <br /> .... <br /> ....._......_............... <br /> _......_......_.._..__...................._....................... <br /> 10. <br /> 12. _...f._._..._._..._........................._ _................................ ........................_..........................._.........._....... _.._.._....__... ...._....._ _ _.._ _..._ _.._.. _....... ....... ....... ...... ....................................................................................................... <br /> Relinquished by(Name&Dept.): ��//�v Date&Time: y ame& ept.): at T' Ship Via: <br /> 02D 3<a <br /> Relinquished by(Name&Dept.): Date&Time: ce' ed by(N ept.): D te& e: Bill of Lading/Airbill No.: <br /> 7 <br /> Relinquished by(Name&Dept.): Date&Time: Received by(Name&Dept.): Date&Time: <br /> SAP Acbounting Data: Billing Contact: Billing Address: <br /> �f <br /> I <br /> I <br />