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CHAIN OF CUSTODY [Fag—e <br /> CONSULTANTS NAME CONSULTANTS ADDRESS <br /> Blaine Tech Services, Inc 1680 Rogers Ave , San.case CA 95112 <br /> BP SITE NUMBER SP SITE I FACILITY ADDRESS CONSULTANT PROJECT NUMBER <br /> 11193 1 3202 W Hammer Lane, Stockton 01 i [ U - 1. <br /> CONSULTANT PROJECT MANAGER PHONE NUMBER FAX NUMBER CONSULTANT CONTRACT NUMBER <br /> Morgan Hargrave 408 573-0555 x 218 408 573-7771 <br /> BP CONTACT BP ADDRESS PHONE NUMBER FAX NO <br /> Scott Hooton 295 SW 41 s# Street, Suite N, Renton WA 425 251-0689 425 251-0736 <br /> LAB CONTACT 6 LABORATORY ADDRESS PHONE NUMBER FAX NO <br /> Pace- Lily Ba atl 3970 Gilman Street, Long Beach, CA 562 498-9515 562 597-0786 <br /> BP CONTACT REQUESTING RUSH TAT(Print BP Contact Name) RUSH REQUESTED OF(Print Consultant Contact Name) DATEITIME JSHIIPMENT DATE SHIPMENT METHOD <br /> TAT ❑ 24 HOURS ❑ 48 HOURS ❑ 72 HOURS Standard 7 or 14 Days ANALYSIS REQUIRED IRBILL NUMBER <br /> CONTAINERS PRESERVATIVE <br /> Lu <br /> COLLECTION COLLECTION MATRIX <br /> SAMPLE DESCRIPTION DATE TIME SOILNVATERNO TYPE LAB x` $ m COMMENTS <br /> LU <br /> (VOL) SAMPLE# m v o w <br /> + + <br /> o a <br /> c� a LU o^ o <br /> Q O d N N <br /> !- W <br /> i- <br /> Li <br /> /"tom✓-� ' 1 !3 ' X <br /> SAMPLED BY(Please Print Name) SAMPL BY(Sig re) ADDITIONAL COMMENTS <br /> RELINQUISHED BY I AFFILIATION DATE TIME ACC£ ED BY I AFFILIATION (Pant DATE TIME <br /> (Pant Name 1 Signature) Name I Signature) <br /> 1x`101 1360 �Q, lt�� o! to <br />