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CHAIN-OF-CUSTODY/Analytical Request Document Paga or <br /> aceAnalyticaI BUILDING AMERICA Tne Cnano-Cuttod is a LEGAL DOCUMENT All raeva t rNks muss beompate0 e w areiy <br /> ',Itt` Waste Request Only <br /> Section A Section B <br /> Sectlon C <br /> Rebuked Client Information: Required Prefect Information InvokelMormatlon:UPRR-chroons ��� <br /> Consent,Union Pacific Railroad(UPRR) Repon To. Kelly Fuentes Kelly.Fuentexs@ghd corn Site RemediationJ <br /> Group <br /> Address UPRR-Stockton Copy To. UPRR-WM,aehd Corr Fiala Cpeebons <br /> REGULATORY AGENCY <br /> 833 E.8th Street FaI Code.VariousVA-RIIscLabinv Engineer, L NPDES _ GROUND WATER_ DRINKING WATER <br /> Emau To: Gree summa rL <br /> UST _ RCRA r OTHE <br /> Phone. 561-293-8477F. UPRR WRe WR# 5230 AS job no.81 D46-16 PEDD Ske Location Stockton <br /> Requesters Due DMII Lob Project is Lab Entire s STATE: CA <br /> Notes'.see below <br /> Requested Analysis Filtered(Y/N) Ib�a,a <br /> section Matex codes — E -e na xsn x o.,nuow..e ry <br /> Rebuke Client lnlormeEcn COLLECTED MERV'000F =' j^'m+^✓y+�'o ern ��^W my anmmce <br /> e Preservatives - '"'^' <br /> Ddnung Water Iu <br /> WaPor WT O I <br /> Waste Water WWas eim7E WYPo9TE 1- O <br /> Product P i qn Uaonna Z <br /> sol5olld SL - E <br /> SAMPLE ID O� ,OLL 5 $ w �O s f <br /> (A-Z,0.81,1 Air AR w u Z Y : 3 p p <br /> Sampte IDs MUST BE UNIQUE Tissue TS O 11 V p� I 10 0 - O U <br /> ONer OT ct <br /> fe ac <br /> + Q n O N <br /> W F n O o A b C n g>g d o <br /> DATE TIME TE TIME a D i i i i E O m m w or Pace Project No./Lab I.D. <br /> 1 Bin Debns and Sludge s c X X X X I I X X I I I 1 I <br /> z <br /> 3 Drums Oil Sludge pir s C X X X X X X <br /> 4 Y V X )( t IL <br /> 6 r <br /> 6 <br /> 9 <br /> g <br /> 0 <br /> it <br /> 13 <br /> ADDITIONAL COMMENTS RELINQUISHED BY I AFFlUATION TE TIME ACCEPTEDBY/AFFILIATK)N DATE TIME SAMPLE CONDITIONS <br /> 'Passe f0mam mlbal tM215 to revise 6 any STLC a11NIX 1 / <br /> TCLP or irolead and/orgaMfishbloisre aired I ( <br /> (please be cognizant of rola times for conpngency u I <br /> 1 Y <br /> analysts when sentling Initial lotalf V L <br /> Melissa Ibison @ AIS ) <br /> SAMPLER NAME AND SIGNATURE ` <br /> Sam le Pece: t Checklist PRINT Name of SAMPLER: <br /> COC Seal Present/intact:, ! R u g mu &Z. <br /> If Applicable DATE sgrlers E <br /> COC Signed/Accurate: ,LS'_N VOA Zero Headspace: a SIGNATURE of SAMPLER M L an �n <br /> Bottles arrive intact: L.�_N Pres-COroect/Check: <br /> Correct bottles used: may, —Y—,: ,s� <br /> Sufficient volume sent: ,y 7J sae's �J( ' 3.�� <br /> AAD Screen <0.5 mA/hr: ,/y N �I `� 26Juy-2015 <br />