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0 Page 1 of <br /> Chahi of Custody Record 1-site Time Tcmp <br /> r <br /> bp Project Name 3Q04 Groundwator Sampling Event Off-into lnim Tem - <br /> l3Y BUMPAI CO Paa'tfali0 Atlantic Rtchflold Sky Conditions <br /> UP Laboratory Contract N1 tuber: metearological l3ventss <br /> Date: 71VIO Requested Due Date(tmnlrld/yy) Wind S ued• Direction <br /> Scud To: JBIJIGEM Facility No ARCOStation595 (`.onsultant/Contractar. SEC©R <br /> t,ab Marne: SEQI OIA ANALYTILALrGI?M Facility Addtcss-6100 N.Iiwy 99,Stockton ddress 30171GlgoreRdSte'100 <br /> LabAddress 88511rviSDAVe e 117 No. Rancho Cordova,CA 15670 <br /> Morgau Bill,CA 95437 e fat/Lgng 3$.021-i21.2S e-n il HUD kflesorits@seeor.com <br /> lifomia QlobP11011 T0607700319 CoAgvkant/Conlractar Pro cc1'No 7713P.50595 05 0327 <br /> Lob PM. Lisa Race 131,101iM 1'M Contact Chu(Pau!Supple Consultant/Contractor fele/flax 916 8610430 <br /> TeldFax- 408 782 81.56 Address 1'.G Box 6249onsu1tani/Conirscto 13eit1(oslV <br /> Report 1 QC I.avcl blarage,CA 94570 <br /> Invoice to uliant/Conirac r ar)VIGEM (G�rcle) <br /> MGM Account talo tIt/Fax. 925 299.$891 Hl'1G&M Work Zeleasel�lo G25dG <br /> Lab Bahia Order No Matrix Preservaltves Requested Analysis <br /> sa <br /> i3 <br /> ko ko 00 <br /> !tent SampleDDumpllon Time -�s l,ahomfory No. Sample I'olul 1,alCLoug and Comments <br /> a <br /> No <br /> o rh O `q 6 <br /> 1 MW-! X 6 3 X X X 38 02-083911-1212558191 <br /> 3 MAV-3 X d� 3 X X X 39 0206896!-121 2563150 <br /> �2 ' 1 <br /> Y 38 02130891 -1212561280 <br /> 5 MSV-5 7 r n 1 Voo X d 3 X X X <br /> G MVl-iii 7 r er! .3�e X a 3 X X X 18 02144991-121 2566359 <br /> 7 V-7 7 o X a 3 X X X 38.0208771 f-121.2564961 <br /> 8 MW-8 X 6 3 X X X 38.0215675!-121.2561514 <br /> Sarnplct's Natna: �� Relinquished 13 I Alflltatlon ilotc llnic Accept d A I Aifitiatton ate rtic <br /> aT '� <br /> Sam ]ar's Coln ii <br /> "ltncnt Date <br /> Berl M:cthod- <br /> 'Trackmg No <br /> �cltans <br /> 'Place Yes Na Temperature Illank Yes No Cooler Temperature on Receipt '1`rip Blank Y2Xcq�— <br /> 21502ZYlutc Copy-Laboratory!Yellow Copy-131'lG13M /Pink COPY-Consitlta�lttCoutractor <br /> BP(:cc Iicv i <br />