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(17'"'"c" ' 'MX8rCCWANT, b ST.' <br /> 80 Chesapeake Dr <br /> Redwood City,CA 94063 P 0 Box 2180,Houston,TX 77002-7426 (^C C Jf!�L r f,���f , <br /> (415)364-9600 • FAX(415)364 9233 CHAIN OF CUSTODY f! ) <br /> Consultant's Name eA erl t r, �°'f,y C �; /:moi � `,r I Page sof <br /> Address 3 q D; SV 5� B 1 � • , y Site Location Ll r{�Ne-r6hvhc Av `i 6r-V� <br /> Project # Consultant Protect# ( '?�tl� �,�� Consultant Work Release# U L� <br /> Project Contact ���1l�� _ Phone # (�-Z:j �L-e6 1 Laboratory Work Release # <br /> EXXON Contact(, �C� � � Phone # L5r EXXON RAS # <br /> Sampled by (print) C�•1r-� Sampler's Signature <br /> Shipment Method , 6&U 0 Air Bill # a <br /> TAT ❑ 24 hr Cl 48 hr ❑ 72 hr ❑ 96 hr ' ., tandard (10 day) ANALYSIS REQUIRED <br /> Sample Collection Collection Matrix # of Sequoia's TPH/Gas TPI-!/ TRPH Temperature <br /> Description Date Time Soil/Water/Air Prsv Cont Sample# BTEX/ Diesel S M ��, <br /> 8015/ EPA 5520 on,r�� in bound Seal Yes No <br /> 8020 8015 Outbound Seal Yes No <br /> Cr <br /> rn <br /> o <br /> w <br /> 0 <br /> U) <br /> ,v <br /> RELINQUISHED BY/AFFILIATION Date Time ACCEPTED/AFFILIATION Date Time Additional Comments <br /> 7-1 <br /> L�- <br />