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CHAIN OF CUSTODY <br /> E -w i..ly /ileie-,+-IP 6c ,¢,J�-y GAS nset v <br /> —�--_•—••_-- w+Zl REPORTING REQUIREMENTS BELOW: <br /> ettmett�al-tabs� �¢,�<fSs S at�ss�asanis--fx�a+ �.n <br /> Project Manager: f [ SLS Phone#: PDF I Standard Format <br /> Email Address for Reporting: I— � Z! , ryj ceEa# �c 6_ 4 Geotracker!EDF 1 Provide GlobaP ID <br /> Email Address for Reporting: Fax M: <br /> Company Name S Address: 7 L�C.�ynl �Nc..1_ r.,� P.Q#i Project Name: EDD I Equis 1 Data Table <br /> MDL Format <br /> l�f6G G36S;,cE <br /> 4,o. 17 X16eD Project Location:4t3I?; 6 <br /> Billing Address: y 7/ S Data to be reported to State's Database?Yes No <br /> re-- 5e-f —),� f 7 T[�!<� Sam ler Name: <br /> P �aaE�a�-.n EDT!CDPH-Provide Source codes!PWS ID: <br /> Ak-M,3i5 � sampler Signator page,1 of <br /> ANALYSIS REQUST IJ1B USE: <br /> Matrix Table: Preserved?to+arK yes and no it amu,avaaahley I fi+selals <br /> Bin 9: <br /> S=Soil 1 Sludge 1 Solid(circle one) v Yes I STIc Total <br /> A=Air No <br /> DW=Drinking Water x <br /> MW=Monitoring Wells @ m o Co n �1 <br /> GW=Groundwater E � .� .� N a U a v �, <br /> TW=Treated Water r @ @ a E Microbiology <br /> WW=Waste Water — l e o — o ¢ o _¢ a p N <br /> -0 = aE oE n 0E o <br /> j aNc nTE cvQr � <br /> Work Order: <br /> cores DATE <br /> sorce SAMPLINGx summa <br /> SAMPLE ID: <br /> /#—/2 <br /> �r -rte /rs ram S <br /> Lµ-IS /5 ere S <br /> IL—lam /1/s 111D <br /> 1/q--1:I- 4. 15 //--- <br /> Lff r8 .2 1�3 <br /> LLQ—I 9 s1 10 <br /> -z r.5 I� L_ <br /> Relin shed b: DATE TIME Receiv s Remarks: <br /> Relinquished by: DATE TIME Rec i ed by 61 era ory: <br /> atre 42 of 43 <br />