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UW ,fomation. Analysis/Container/Preservative =halo of Custody Page—of <br /> Pres <br /> WR#003272 cnk ! AwlXical <br /> Report to Email To: 112061 Lebanon Rd Qi ❑� <br /> Leah Brinson/(GHD)Rep Name leah.brinsonoghd.com <br /> Mount'"lief,7N 97127 <br /> Phone:615-7585858 <br /> Project UPRR French Camp/Lathrop HazMat City/State French Camp Phony.800-7671811 <br /> Description'Hydraulic <br /> I Fac 615-7585859 O� t <br /> Oil S ill Icouected /Lathro <br /> Phone 317-291-7042 Client Project# Lab Project# it <br /> i L <br /> USE#Yt5tilVM WR#003272/Mike Algots <br /> Fax: Ibo8oS( 0086 <br /> _ r T <br /> 'Collected # <br /> by(print): Site/Facility ID# P.O. r <br /> Carlos Sanchez E I Acctnum:UPRRAMER <br /> Collected by(signature): � Rush' (Lab MUST Be Notified) Quote p U , Template: <br /> l <br /> Same Day Five Day N I = Prelogin: <br /> Next Day _S Day(Rad Only) Date Results Needed O i TSR: <br /> Immediately ; <br /> Two Day _to Day(Rad Only) No. ( <br /> Packed on Ice N Y X _Three Day PB- <br /> of O ` <br /> Sample ID Comp/Grab Matrix• I Depth i Date ; Time mfrs O O Shipped Via: <br /> 00 1 <br /> Remak, I 5..Pleal1ab.nNJ <br /> #1 Absorbent/Debris Grab OT Grab 11Z-ZS-'lo !j jr,Nr Z X <br /> t I <br /> i <br /> •Matrix: Remarks: sample Raceint Checklist <br /> s-Soil AIR-Air F-Filter (8015)TPH quantified in the following ranges with contingencies for 96 hour pH Temp CDC seal Present/Intact: _NP LY _N <br /> COC Signed/Accurate: 1r _N <br /> W-Groundwater B-Bioassay <br /> fish bioassay If the following levels are observed:TPH oil 2 10,000 mg/kg,TPH Bottles arrive intact: _N <br /> WasteWater Flow Other Correct bottles used: _Y _N <br /> W-Drinking Water Samples returned via: n ------ - sufficient volume sent: _h _N <br /> T-Other _UPS _FedEx _Courier �Y JT 'Tracking C if Applicable <br /> VOA taro Headspace: Y _N <br /> Relingfui�shed by:(Signattuure) Date: Time. Received y:(Signature Trip Blank Received: Yes/ho Preservat ion correct/checked: —Y N <br /> (//r/1.1��5 i►N6lCZ <br /> 12-1,1-20 / <br /> 3-20 Z (/ _ J HCL MeoH - l <br /> / TBR <br /> Relinquished by:(Signature) Date: Time: Received by:(Signature) G ITemp:6QA3'C Bottles Received: If preservation required by Login:Date/Time <br /> ,rZ <br /> Relinquished by:(Signature) (j" Date Time: Received for lab by:(Sign atu Date:,,,,,, Time: Hold: Condition: <br />