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.. I r <br /> Lab Name: IICI XJII� EQUIVA Services LLC CHAIN OF CUSTODY RECORD <br /> Lal?Address: Camping Contact(s)for Invoice: INCIDENT NUMBER DATE: -7/7.1 O <br /> �I]� 1 11PAGE: r , <br /> TEL: FAX: 1'eclinical services 1 i y $ 9 g rj g 7 4 ! OF <br /> EOUWA PROJECT CONSULTANT(Name WW Co n wyk SITE ADDRESS: <br /> Owen Ratch e-Cambria Environmental Technology,Inc <br /> ADDRESS: 341 East Main Street, Ripon,California <br /> 6262 Hollis Street EOUIVACONTACT: I CONSULTANT PROJECT NO: <br /> clTr: <br /> Karen Petryna ! 243-0324 <br /> i <br /> SAWLER(S):(SIGNATURE) <br /> Erne Ille California u,avar <br /> TEL: FAX E.WAIL oratchveO <br /> 510 450-1984 (510145 8295 cambrilr mcom <br /> TURNAROUND TIME(BUSINESS DAYS) V <br /> REQUESTED ANALYSIS <br /> ® 10 DAYS❑ 5 DAYS ❑ 72 HR ❑ 48 HR ❑ 24 HR 0 c24 HR �f <br /> (] LA-RWOCB REPORT FORMAT UST AGENCY: San Joaquin County <br /> o Lo <br /> MTBE CONFIRMATION: HIGHEST HIGHEST ger BORING ALL G to r rn <br /> SPECIAL INSTRUCTIONS OR NOTES: 'TEMPERATURE ON RECEIPT(C) <br /> u a Z u1 a c O <br /> E Ln m E t <br /> Totalizing Water Meter Reading- <br /> zz'955o0 <br /> K d o _ r M W — u <br /> a W W Y + Q (J O <br /> cc <br /> Detection(imus: TPH =50 b BTEX=0.S b MTBE=0.50pb a w �_ ncc N v �, I z i > ° <br /> sE= Field Sample Identification rL <br /> gA"'P""G MAT- Hr,.oF x z u m r m a $ a $ U 2 <br /> ONLY P DATE TIME AIX carr. LL m m > ul ILL N > > 9 > 0- <br /> See <br /> Sea nate <br /> E-1 ��°} I�.IO W 3 VOA X X r� <br /> Ae Signature) Received by:(Signature) �I Data: Time: <br /> RT <br /> 7y,.(Signttura) Aecel%,"by:(Signature) Data: Time: <br /> I <br /> Refittttuishedby(Signature) eCa by: Dale: Time: 31 <br /> li 0_7AAb I I toLl < r <br /> � I <br />