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URSGreiner Chain of Custody Record <br /> 2520 Venture Oaks Drive, Suite 250 <br /> Sacramento,CA 95833 Page of <br /> (916)929-2346 (916)929-7263 FAX <br /> Project Number: Site Name: Analytical Methods:List number of containers,preservative per method <br /> (e.g.for sample of 3 VOA vials with HCI,record 3,A in box) <br /> -�4- QCk4- oil <br /> CO 0 <br /> Sampler's signatures: m°�Q j�N <br /> At(b <br /> Date Time Matrix Grab Comp <br /> `jple Number Sample Location (MM/DD/YY) (24 Hour) SACODE MET �� �Q Remarks <br /> -5'&1 _r 2-5- - _ 06-20-00 N- j -X <br /> S9I so �._ tvso X <br /> Vo <br /> 567 5`0 3KS K <br /> I'Ir1iZ-E6 T.�'-- Z 0(0-z0-00 [uoo Wa K [!OCAS <br /> S;ES-- ZS STs 3 06-z►—IAC/ 0835- 5 <br /> Sr33 — -o <br /> CW "�'� si3" C 1 167 W C>^ )C' S- 40 i'...L Uor's <br /> Z s X 'S/eir <br /> 0(0-2)rru 1[ 3s- cA' N I <br /> - ! 07 a+o-zr- 17aC, ktd -pir X [a <br /> Matrix Types:A-Air;GS-Soil Gas;GE-Gaseous Effluent;P-Product;S-Soll/SedimenUSoild:T-Tissue;w-water, Preservation:A-HCL; B HNO3; C-H ZSO <br /> W 4; D-NaOH; E-Ice; F-(specify) <br /> r,-Groundwater; 0-Other(specify) <br /> MET G-Grab' To-Tedlar• A -Summa <br /> RELINQUISHED BY:(siGNATURE) DATE TIME RECEIVED BY:(SIGNATURE) RELINQUISHED BY:(sIGNATURE) DATE TIME RECEIVED BY:(SIGNATURE) <br /> ` r Z X10 9 5-L( C 7 <br /> RELINQUISHED BY:(siaNATuaE) DATE TIME RECEIVED BY LABORATORY: N <br /> TIME LAB Name and LAB Contact: V r l-r <br /> (SIGNATURE) <br /> Vr'lle <br /> Remarks: SEND RESULTS TO: <br /> COOLER ID: Ak/( Co k <br /> 4 IL C je y FAX Preliminary results: (916)929-7263 <br /> White-Original to Accompany Samples Yellow- URSG Main Office Pink-URSG Field Office <br /> No. 5024 <br />