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l zAna0a' CHAIN-OF-CUSTODY/Analytical Request Document <br /> ra.ean�nreN The Chain-of-Custody is a LEGAL DOCUMENT.All relevant fields must be completed accurately. <br /> A <br /> Section A Section B <br /> Section C <br /> Required Client Information: Required Project Information: Invoice Information: j Page• Of <br /> Company: Arcadis Report To: Scott Hackman Attention: Paul Holt <br /> Address: 6296 San Ignacio Ave. Copy To: Julie.d.munn arcadis.com Company Name: UPRR <br /> San Jose,CA 95119 UPRR-Sysdataghd.com Address: :Regulatory- Agency <br /> - _ <br /> Email: Scott.hack man arcadis.com Purchase Order#: Pace Quote: 9900758938 <br /> Phone: 916-786-7369 IFax Project Name: French Camp CA-Lathrop Intermodal Yard Pace Project Manager. lennifer.gross@pacelabs.com, tion ac <br /> State/Loca ' <br /> Requested Due Date: 5 da Project#: 7036 Pace Profile#: 4063011 StStCA!San Joaquin <br /> -R uested Analysis Filtered <br /> MATRIX CODE — 0 COLLECTED Z Preservatives - <br /> orma'y watr ow o <br /> Water WT U <br /> Waste <br /> P,&— P <br /> SAMPLE ID <br /> aiusob or o START END a <br /> One Character per box. Wipe WP M w = <br /> a O <br /> (A-Z,0-911 cr <br /> ar nn o a w ¢ ci'i :. p r <br /> Sample Ids must be unique oo- os X w m p m 6 o `° <br /> Lu 0U m M <br /> z m` ;Q, , <br /> ~ DATE TIME DATE TIME # o o T z z O m <br /> U0Ll fa 2 u 1015 x <br /> -ItwEi 5S- S- V+ st k <br /> G17 41 t <br /> 6-M 0�1 I x <br /> S— `�-33 S'- GU2. Uq2� l O l S <br /> a SS-2' 30 s C °- 164Z Xi X ttOLD r <br /> 11 � <br /> 12 <br /> ' ADDfr10NALCOMMENTS .RELINaVISHED$Y'AFE7EfAYWN'wr DATE - TIME .ACCEPTED BY)AFFIIJATION -:DATE TIME SANPLE CONDfT10N8 <br /> - <br /> _ ..... .. -.� .:. <br /> 4M-Frerc'+CzmoCA-�s;� J {•�i1'(� 515 f'}"�-G �v Z 'I ze�I ���� <br /> !V jz Za I?tw �� x <br /> ZILZW IV-S ) 2-L4 <br /> SiNNAME AND SIGNATURE00 <br /> � PRI Name of S PLE U o <br /> d o r <br /> SIGN E o S PLER- DATE' '(�:� E u z <br />