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C C C C C [ C C C [ C C C C f C C 62.441t,/r11991 C <br /> .10 Paciffe Gas and Enwhorvnanul Affdrs <br /> E/eclWe Company- <br /> Chain of Custody Record a r/;Zw 033* S v`f 5 . <br /> From: Pacific Gas&Electric Company G&E Facility p Sample Site Ship To: Lab Name: R <br /> Address or Location: 1001/0 ./ Address: <br /> City: `Q2! �C A- .CA (zip) %r4c>•f City: CA (zin) _ <br /> Contact Name/Phone No.: ZDct Sele leS_46 Phone No. <br /> Contact Name: <br /> Turnaround Time Analysis Requested <br /> NORMAL(10 days or less) (M RUSH �' OTHER,Specify <br /> on oam AM= D .� <br /> []TELEPHONE KFAX Give Results to: 5 - 121 �' pLA <br /> NAM PNFA]C 1 /x <br /> Project Name- Project Supervisor(Name/Phone No.): 1� 111 �0 6 f <br /> Sampled by: (Sign ure) (Print Name) C <br /> Sample No./ Sam led Containers <br /> Equipment Serial No. Date q Time Sample Type/Description eNto. Size 0 Remarks <br /> s--------------- �L �p -----... r /�sroC1r/ � ..... --{'---- --------- - -- -- -- -- =- -- --- -- -- /4, l CGhyels rt <br /> .Q�3.-- =-`= - -1 - ------ 1.31-- „'�-------- --�--- ------- --- -- ------------------------------------------ <br /> 4. <br /> _ ' ---- - ! <br /> -------- - -- -- - ....... .......... ------------------------------------._....8 `l >. ,� <br /> ----- -E�- --•------- -� ..--- ----.. <br /> ------- I <br /> _t <br /> - -------- <br /> -------- <br /> ---------­------------- <br /> -- ---------- ---- - - = -- --- - - - -• - - -- <br /> 9. <br /> ------ ------ ----------------------------- ...-- ------ -- -- - - - -- -- --- -- ------- - --�.---- - .... . <br /> ------------------ <br /> ii:----------------------- ------ - . --- -----..-----.---------------- ....-- ------. -- •- --- --- -- -------•----------------•------ <br /> Rewished (Nam e D i R ived by(N &Dept.): D t Ti Ship Via: <br /> Relinquished by I <br /> ame& pt.): Dae&Time: Received by ame&Dept.): = Date&Time: dill of Lading/Airbi o.: <br /> Relinquished by(Name&Dept.): Date&Time: Received by(Name&Dept.): Date&Time: <br /> SAP Accounting Data: Billing Contact Billing Address: <br /> Notes: I. Samples are discarded by the laboratory 90 days after results are reported unless other arrangements are made. Distribution (See note#5) <br /> 2. File a copy of this Chain of Custody Record,complete with appropriate laboratory signatures,with the test analysis results. White: Laboratory <br /> 3. `fhe first"Relinquished by/Date'is the shipping date unless otherwise noted. Canary: Originator <br /> 4. The final PCB results will be the cumulative results added together for each PCB. fink: Sampler <br /> 5. When this form is computer-generated,send the completed original to the laboratory,and make copies for the originator and sampler. <br /> ®PG&E November, 1998 <br />