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'Sim <br /> LL OIL COMPANY RMRAIN OF CUSTODY RECORD dale: 9? <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No pogo z of <br /> Silo Address: 620 W. <br /> Charter Way, , StocktoEr; CA Analysis Required _ <br /> LAB: c�JQy . <br /> WIC#: 204-7524-4305 - <br /> CHIC)(ONE 11)Box ONLY Cr/At I TURN AROUND TIME <br /> Shell Engineer: Phon© No. (510) C Moalomg 41 1 phot" ❑ <br /> Alex Perez 671-6168 it•Igr•tlipo0on ❑ u11 At hours <br /> Fax : 675-6172 ❑ <br /> Cansullani �a e A dress: � <br /> Blaine Tech Serv& �ces, Inc. � SoMClouYy/D4potal ❑ ut1 16 dart ®(Notmoo <br /> 1680 Rogers Ave. , San Jose, CA 95112 water <br /> Consultant Contact: Phone No (408) c�ttlyml.�ata1 , "" other ❑ <br /> Fran Thie 573-0555 �' N <br /> Ga <br /> N N � � sea/Alt Rent or Syt <br /> Fax Il• 573-7771 o a N O J1µ ❑ usi NOM Notuy lab or r <br /> Comments: li walat Rom Of Sys 416] toort at►ouiW of <br /> O O 0 M Go O A M � It/It htt TAr <br /> _ x <br /> Sampled by: �� N T Z Olh•r ❑ <br /> a <br /> b a Q 0 ° <br /> N C UST AGENCY: <br /> Printed Name- �-'t �. � 4 ¢ a o c o a, N <br /> n. a w w <br /> "� x T 1E s v a o °� MATERIAL SAMPLE <br /> Sample [D Dalo sludge soil Walor Air coo <br /> t j U V a V DESCRIPTION CONDITION/ <br /> COMMENTS <br /> x X 0� <br /> S7 <br /> r <br /> LLL]Rellnqulslta Y(slgnaW. Printed Name <br /> Dale S ( gnalur Prinlad Narne. Dale <br /> Tlmo C! - E ~ <br /> Reilrlquishad By(slgnalure): Nlnlud Name, Dalo eco sig alum). Prini Nano ` <br /> Timo• Da e.14 <br /> • <br /> Rollnqulshod 8y(slgnaiuro) Prinled Nama• i�t] nmo <br /> Dale Rocolvo alum)• Prinled Name. Daly, ' <br /> nmo• <br /> CQPY-QF Till <br /> Tlmo <br /> nw 01 On M G/MI <br />