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CHAIN-OF-CUSTODY i Analytical Request Document caQe a <br /> aceAnalXical BUILDING AMERICA' The Cham-ofCustody is a LEGAL DOCUMENT All relevant fields must be completed! a <br /> acrutery <br /> "a II��IIIIIIWWII�I�I11 Waste Request Only E153 <br /> Section A Section B Section C <br /> Requiretl Client Inf.rm. n'. Reaubed Protect Information: Invoice Irdounati.n:UPRR-coed one <br /> Comp.ny Union Pacific Railroad(UPRR) RaPon To. Leah Bdrroon(GHD)l leahbnnson@ghd.com Saa Rsmetlletlon Gioup- <br /> Address. Cagy To: UPRR-WM1and cc Field Opentbna REGULATORY AGENCY <br /> BMam Jewbsen 916-781 <br /> Fao'Dotla VarloultVA-Miscl-ablDY Enginesdng- NPDES GROUNDWATER DRINKING WATER <br /> 7 <br /> EmaiTo: Eah bnn50n¢GPC CCfI' Sr.Lova m Stockton man _ UST _ RCRA _ OTHE <br /> Phone: - UPRR WRe WR 6113 - AIS Job#81046-50 %DO Site Location Stockton <br /> Requested Due DaM1rtAT: Lab Protect a Lab Proate8 STATE: CA <br /> Requested Analysis Filtered(Y/N) <br /> H <br /> Section Menta COMB i E as <br /> a.Ralraa cuam im°rmatl°+ hwTmxrcooE a COLLECTED PreservativesOnn 'r <br /> z <br /> WaterWarr DW <br /> Water VJA U ccuRPN1a LNo iiE <br /> N/aatet VJJJ ^ m Si WT laaavue <br /> Protlud P <br /> Soil/Solid SL o0 O D' P <br /> SAMPLE ID °,Nilo, 1APP w zti <br /> IA-Z.691;) Alr AR a w 2 <br /> Samoa IDS MUST BE UNIQUE p ins,e TOT O Z w P -6 B F '} -/VI"'♦ <br /> P v z 2 e <br /> K n n u_ O N 5 `m C is <br /> £ ~ z s . i = i i E O m $ Or Pace Project No./Lab I.D. <br /> f rgi DATE TIME <br /> T.- T., �+ <br /> 1 Track Sand/Sludge SL G x X1 X1 I IQ <br /> 2 Track Sand/Sludge/Debris SL C -otts s -0 1 CIA L"2- 1 x x x <br /> a <br /> t <br /> a <br /> 8 <br /> 1 <br /> 9 Sam le P.e_ei Che-.�_:ea <br /> 9 COC Seal Pcese nc :r.tact:;a f Applicable <br /> CCC Signed/Accurate: L N vCA Zero Headepace: <br /> tit Bottles arrive intact: N Pres.Correct/Check: Y <br /> 11 Correct bottlee used:d. <br /> Sufficient volume sent: _ ti <br /> 12 RAO Screen <0.5 mR/hr; A N <br /> Apprp IUM.COMMEMM RELNQURPED BY/AFFILIATION DATE TIME ACCEPTED BY I AFFMIATION DATE TIME SAMPLE CONDITIONS <br /> -Plea..lorwartl Indial tote,to review a any 51 LC andsca11 <br /> T P a eNtr ash bio me used L/l 3t/ 04 [^. -moi Z-7 C"', C L} _t C-� Z Z <br /> (Pleas.be c.,n.nt.1 hold times for contingency -`� <br /> nal ori wh.n.endin initial tot., <br /> / <br /> Amedran Ima9rala l SerwMs-Melissa(Neon l l <br /> SAMPLER NAME AND SIGNATURE cv ` <br /> yyi <br /> PRINT Name oN SAMPLER: <br /> DAT£Sigurd E 8 rS <br /> SIGNATURE of SAMPLE : <br /> Li <br /> 20-Juy-2015 <br />