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CHAIN-OF-CUSTODY I Analytical Request Document Page of <br /> ace Analytical BUILDING AMERICA The Chain-of-custody is a LEGAL DOCUMENT All relevant fields must to completed accurately <br /> Waste Request Only H075 <br /> Section A Section B Section C <br /> Raqulnd Client Information: Required Prolan Informeeon Invo¢eI .muibom UPRR-check ore <br /> company:Union Pacific Railroad(UPRR) Report To: Leah(GHD) Sae RemeUlil Group- <br /> Addrese 833 E Eighth Sl,Stockton,CA 95206 Copy To: UPRR-WMAghd.corn Fleaopernrorn- Greg M,uu.)J. <br /> Siva REGULATORY AGENCY <br /> reality Code VarcaJsVA-MISCLabinv Englaaedn,- _ NPDES GROUND WATERi_ DRINKING WATER <br /> Emai TpLeah/Ma ssa Iblson Sae Local Stockton Shop Other:Hal,Me I I_" UST _ RCRA r OTHE <br /> Phone 310-935-8304 F- UPRR" V / AIS Job No 79023 PEDD Site Location Stockton <br /> Requested Due DatalFAT: Leh Prolene Led Profile STATE: CA <br /> Requested Analysis Filtered(YIN) <br /> y <br /> Election Minn.Codes u n i <br /> Required chem mformeao� LwTalxlcooE e o COLLECTED Preservatives P <br /> DnnNng Water DW y U Q _ <br /> Water WT F �j OOMPOETE a <br /> en,Water WW a STMT EM'oMB W n Z <br /> Soinolid SL <br /> SAMPLE ID w� WPOIL <br /> (A-2,Dal) Air AR pr p z F 9 <br /> Sample lDa MUST BE UNIQUE D. TOT O w Z rSae O g V <br /> x w c D a — <br /> u u o a 0 O y a+ c _ 5 8 x y <br /> 1 f N c <br /> PATE TIME <br /> DATE TIME a n i = z z O` y m S ¢ Pace Pro ect Ii Lab I.D. <br /> t Used oil rags/ppe rags/ Debris j Kn x x -1 x I z I x —O <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> B <br /> 1129 <br /> 10 <br /> 11 <br /> ADDITIONAL COMMENTS RELINQUISHED BY I AFFILIATION DATE TIME ACCEPTED BY I AFFILIATION RMnnME PLE CONDITIONS <br /> •Please rorwardmmai toms,to review d any STLC anvor TCLP or nolea0 anNorbfishWIz caredYY(please.cognizant of hold times for contingencynalysis when sendin Initial totals //q <br /> SAMPLER NAME ANDSIGNATURE c <br /> - PRINT a; <br /> of SAMPLER'. <br /> � z SZ <br /> Sample AEC t L2Cs'15t SIGNATURE of SAMPLER' OM 519rcd / U v <br /> COC Seal Present TI ntacv Y If Appl>•cable C/ <br /> CDC Signed/Accurate: 7Y `v VJA Ze rc Headspace: _Y N <br /> Bottles arrive intact: 7FY Pies.COrri Check: —Y—h <br /> Correct bottles used: rY N <br /> Sufficient volume asnt: r Y_N 20 July-2015 <br /> AAD Screen <0.5 al <br />