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EXXON COMPANY, USA. n� / �a CHAIN OF CUSTODY RECORD NO Page d of <br /> �'l f ANALYSIS REQUEST <br /> Exxon Engineer Dann Rouse Phone 925 246-8768 (CHECK APPROPRIATE SOX) OTHER <br /> Consultant Co Name Delta Environmental Contact Jim Brownell ❑ ❑ © ❑ <br /> Address 3164 Gold Camp Dr Phone 916 638-2765 ❑ a = J <br /> ° ❑ ❑ Q m <br /> o <br /> Suite 200 Fax (916) 638-8385 0 N i` <br /> p C. ❑ a <br /> Rancho Cordova,CA _ ❑ r ❑ -J <br /> d Q ❑ J F <br /> RAS# 7-3708 Facility/State ID#(TN Only) > o o ❑ ❑ C3AFE# {Terminal Only) Consultant Project# z 0 ❑ a w Q r <br /> N a <br /> Location 2765 Count Club (City) Stockton (State) CA 0a ° LU ❑ o <br /> 71EE LlCBM 11SDT z J ° °� ° ❑ ❑ ❑ ❑ ❑ o <br /> N Q C9U m ¢ J M <br /> U <br /> Consultant Work Release t 19909828 STS# �, iM - -L— z w ❑ N o04 <br /> O LLL O J r m ❑ m co h ¢ p Q <br /> Sampled 8y Blaine Tech Services, Inc03,,, /�J, _�Sc�✓G,.�, �.�, LL ¢ Q U "r o = W N a = <br /> O X C7 C7 m > d a Q M w <br /> SAMPLE I D DATE TIME COMP GRAB MATRIX GTHER PRESERVATIVE o 0 F j z xs z J a m 4LU <br /> F Q a F <br /> HzQ 504E A!R z v m a O °� j vii a a ti J 1- (y N <br /> 11.1 l�;Zr 'M lit ZQCA <br /> I I <br /> 3 <br /> ��- E II 7az3 <br /> V' y V <br /> 000, <br /> TAT SPECIAL DETECTION LIMITS (Specify) REMARKS <br /> 24 HR * 72 HR <br /> -- EXXON UST <br /> 48 HP 96 HR * CONTRACT NO <br /> Standarc X *Contact US Prior S02317M01 SPECIAL REPORTING REQUIREMENTS(Specify) LAB USE ONLY OT# Storage Location <br /> Other to Sending Sample `� <br /> —' � �7j/ ZI '7 Z? 3 <br /> Other <br /> Standard ❑ QA/QC Level CLP ❑ El FAX ❑ iso FAX C O-C W i REPORT WORK ORDER# B WORK RELEASE# <br /> Relinquished By Sam ler �` Date Time Received By <br /> CUSTODY Relinquished B Sampler /^- /iy 9;Jd• 4 <br /> Y p ate Time Received By <br /> RECORD Relin cashed B SamplerAal q Y P Date Time ;Rived Labor o <br /> Cooler Tem G <br /> ANlJWC8�PL=POF , 888Wcharwe, I n 4 X13)�01 ow (710-89�Ph =9rgjW <br />