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InPack Gas and <br />Electric Company - <br />Chain of Custody Record <br />From: Pacific Gas & Electric <br />Address or L cation: <br />city: <br />Contact Name/Phone 1 <br />2-a0c — Oil- Ot 3 t <br />E] PG&E Facility E] Sample Site Ship To: Lab Name:. <br />CA <br />Turnaround Time <br />E] NORMAL (10 days or less) XUSH OTHER, Specify <br />❑ TELEPHONE O FAX Give Results to: r"S(�3 0) P(7 1, Ct`� <br />u.me m nvrax <br />Phone No. <br />Contact M <br />614114190 21991 <br />rawer rdt8rr <br />,�0<3o i <br />CA (Zip) <br />Analysis Requested <br />is%..-..-... �1r . (. 4-i................- -------------- ---- ---------------------------------- ............ <br />f- ------------------------- -------- -------- --------------------------------------------------------- ------------ ---- --- <br />r:---------------------------------------------------------------------------------------- ---- ---- ---- --------------2`-�� ------------------ <br />----- ------------­-- -- ---------------- <br />-------- - - - - ---- - - - - --------------------------- - - - - ------------------ - - -- - -- - -- - - -- - -- - - - --- - -- - -- - ------------------------------------------ <br />r---- ---- ----- ------------------------------------------ <br />0 <br />Notes: 1. Samples are discarded by the laboratory 90 days after results are reported unless. other arrangements are made. <br />2. File a copy of this Chain of Custody Record, complete with appropriate laboratory signatures, with the test analysis results. <br />3. The first "Relinquished by/Date" is the shipping date unless otherwise noted. <br />4. The final PCB results will be the cumulative results added togetherfor each PCB. <br />5. When this form is computer-generated, send the completed original to the laboratory, and make copies for the originator and sampler. <br />Bill of Lading/Airbill No.: <br />Distribution (See note N5) <br />White: Laboratory <br />Canary: Originator <br />Pink: Sampler <br />®PG&E November, 1998 <br />