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❑ 819 Striker f Suite 8•Sacramento, CA 95834• (916) 921-9600 FAX <br /> 916` 100 <br /> y { <br /> AIN OF CUSTODY ❑ 1900 Bates Ave., Suite LM •Concord, CA 94520 • (510) 686-9600 FAX (510) 686-9689 <br /> Mobil Oil Consulting Firm: L f Station No./Site Address: 0y— 3y — ra <br /> Address: --� �� Q� Project Contact: sa <br /> Ci!y: `� /'� G c <br /> �-; State: �/sMobil Oil Engineer: 7 �(/� <br /> Tel:k6 �s� l D Fax.: 7'0 �Or/' zi� ���a <br /> Sate ler s si nature <br /> 8 CO G <br /> N N co 3 � <br /> EI <br /> CD W m �, a Q 0 2 Code 1 Emergency <br /> m a H a r n. ! Q N 'c <br /> o o a w o 0 o uwi t i W m Response <br /> Ci CL O V CO ¢ 2 .� h v O N N O W <br /> U lel 0 9❑ m 4. �_ ❑ 31 <br /> 0 U T C e 2 Site <br /> E u, w o ►° Q 3; Assessment <br /> v� m E c a ro Z Q Q Q nb <br /> 03 w w w F -1 _j w a m m j 1 Code 3 Remediation <br /> 17P- <br /> O '. BrJ (Plan Devlpmt.) <br /> �� lO x Code 4 = Active Remed. <br /> 1 8s (install./Start-up) <br /> t Code 5 0 Active Remed. <br /> (oaut) i <br /> Code 6 Passive Reined/ <br /> Monitoring <br /> Code 7 Closure <br /> i <br /> Code 8 Construction i <br /> Code 9 0 Litigation/Claims <br /> Fines <br /> Retingeashed by: DatelTime: Dale ime: Tumaround Time: (check one): <br /> Normal Same day <br /> ReMnqu l D tefrime: ate/Time: 1 day p day <br />'kAll 5 day <br /> Relinquished by: DataMme: Aginelvi5trarn Lab by: Date i <br /> r <br /> 5 1 r Sample Irat <br /> F� <br /> amarks: intact on ice <br /> I <br />..0 <br />