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# !- I�iw #1�■ w � add 11=111i � M) <br /> E ON COMPANY, USA. 201 � CHAIN OF CUSTODY RECORD NO Page Z of Z <br /> V'J <br /> Exxon Engineer Darin Rouse Phone (925) 246-8768ANALYSIS REQUEST OTHER <br /> (CHECK APPROPRIATE BO <br /> Consultant Co Name ETIC Contact John Ortega 0 ❑ ❑ <br /> co <br /> Address 144 Mayhew WayPhone 925 977-7914 ❑ o <br /> Walnut Creek CA 94596_ -- Fax (925) 977-7915 N ° ❑ o fl o <br /> C <br /> M N w J W C7 <br /> r <br /> a U � <br /> RAS # 7-3942 Facility/State ID # (TN Only) LU ;� <br /> AFE # (Terminal Only) Consultant Project # o 0 ❑ O <br /> M N <br /> Location 4444 N Pershing Ave (City) Stockton (State) CA Cr X' Cl f° V) ❑ <br /> F-1EE 13C & M 1:1SDT z }� 3 J ❑ ❑ ❑ 0 <br /> Consultant Work Release# 19909830 BTS# d1vaS16-y/ = ❑ a R <br /> Sampled By Blaine Tech Services, Inc/ Print Name GL�.7 6M _ 0 co <br /> ? N a m Q o r w ° <br /> q �, o <br /> _ q $ ¢ O (7 m a a u a <br /> SAMPLE I D DATE TIME COMP GRAB MATRIXOTHER PRESERVATIVE O � a w <br /> 8 G a <br /> 3 °a 2 Z s O I- <br /> Hz0 SOIL AIR 2 m a Ova <br /> L,v w-7. s,(./mo 11 z`i NG 3 x CA <br /> T�j X <br /> TAT SPECIAL DETECTION LIMITS(Specify) REMARKS <br /> 2; I IH 72 HR EXXON UST <br /> id 11A 96 HR CONTRACT NO <br /> Standard X Contact US Prior S02317MOl SPECIAL REPORTING REQUIREMENTS(Specify) LAB USE ONLY LOT# Storage Location <br /> orhor to Sending Sample n y� <br /> QAIQC Level <br /> Slandard ❑ CLP ❑ Other❑ FAX ❑ ❑ FAX C O C W 1 REPORT WORK ORDER# LAB WORK RELEASE# <br /> Relinquishe Sample r Date Time Received By <br /> `7 ( "dC <br /> CUSTODY OernVoi5d By Sampler Date Time Received By <br /> RECORD Relinquished B Sampler I Z q Y P Date Time nre y Labor t J�v <br /> Cooler Tem �— <br /> SHIP SAMPLES BACK TO SPL INCORPORATED 6880 Interchange Drive Houston TX 77054 Ph (713)660 0901 Fax (713)660 8975 Ph 1 800-969 6775 <br />