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Chain of Custody_Record Page l�of <br /> UK* Facility Name: DVI -site Time: Tem <br /> Site Name: Bum Pit Off-site Time: Temp: <br /> Sky Conditions: <br /> for California RnO mm <br /> ESD State or Lead Regulatory Agency: RW=-Cenral ValeyRegbn . MeteorologiW EvenMts: <br /> / Requested Due Date( /dd/yy): Standard TAT Wind 5 <br /> (/..N Duecuon: <br /> lab Name:CLros a Tom kin;Ltd flin,.Address: ConsWtanttCmmactorURS <br /> sess:2323 FTM Strea Address: 2870 Gateway Oaks Drive,Suite 300 <br /> CA 94710 Site Lefton : N/A Secrimenm,CA 95833 <br /> Lab PM.hbke Daryl ucst ifomia Global ID No.: SL205363007 OoSu taNContraclor Project No.: 17326382.07000 <br /> elelFax.510.4860900/ EnfOS Project No.: N/A COnSutent/Coatrsctor PM: Vernon Elam, <br /> RESD Contact Sim Desi 'on: DVI-Bum Pit cidFm: 916.679.2000/916.679.2900 <br /> Address Phase WBS: mOmo ' welhi T @ Level: Leve]2 wnh EDF <br /> Sub Phase/fask: Anal cal mad EDD To: Marcie Redmond unto m <br /> Tele/Fax: Task Code. 07000 nvoice to: URS <br /> Lab Bottle Order Na: Matrix arontainen w/Preservative RequeslM Analysis - <br /> t <br /> Imm <br /> Na Sample Ikstription f G Laboratory No. Sample Poiot Lat/1,ong antl i <br /> 9 F Comments <br /> to o" ' $ ° <br /> S 2 c <br /> I MW-&BP / I x 3 3 x I 13xVm <br /> d 2 MW-&BP / x 3 3 <br /> 'f x x z x x Ix250m1,2x500m1 <br /> 3 MW-"p x 1 1 x 1x500ml <br /> 4 Iv1W6-BPz I I x Ix250m1 <br /> 5 MW-7-BP o x 3 3 z <br /> 6 MW-7-BP �Ot%0 z 3 3 IX250 <br /> 5 x x z x x 1x250m1 2z500m1 <br /> 7 MW-7-BP 6 6 z 1 1 x Ix500m1 <br /> 8 MW-7-BP / 0 x Ti I <br /> x Ix250m1 idass <br /> 9 <br /> 10 <br /> Sampkfs Name: Relioquia6ed By/Aniliedon Date Time Aue By/Amtution Date Tim< <br /> Sam let's Com URS <br /> )� <br /> Ski rent Date: <br /> Ski ment Method: <br /> Ski ment Trackin No: <br /> ttial Instneti0as: Ani----( horde,m16de,sWfem arW nitrate);Tocol metals&.Dissolved:arsenic,barium,cadmium,chromium,copper,icon.Iced, <br /> man a ma Mum,mere mol mum,nicke selenium,silica Dissolved Metals:Filter&Preserve at Lab! <br /> 4�1 Custod Seals In Place Yes No Tem Blank Yes No Cooler Temperature on Receipt o£/C <br /> Tno Blank Yes No <br /> O <br /> tT <br />