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if li <br /> i. <br /> { CUWIN OF CUSTODY Pate _J_ of _J_ <br /> Late CLS <br /> r <br /> 1 <br /> Report results to ,I� TAT Standard <br /> Name Ben Henll gbvbvr Project information <br /> Company l:NSR I Site Address 1665 Paa is Ave, Stockton.CA 95204 <br /> Mailing Address 10411 Old Placerville Road 4 ENSR Job# 06940-357-100 <br /> City,State,Zip Sacramento,Ca 95827-2508 11 Unocal Jab# 2859 - <br /> Telepllone No 91&362-7100 11 Global ID# TQ60T700123 <br /> Fax No 916-362-8104 f aly5es Requested <br /> Sgecral irntruc3s m andfar spe+ciric regulatory mqutmments <br /> sn o <br /> ,31ri�a =Mi Fora: o <br /> _ � � Sample CnndltionfCatrrments <br /> 5a is lde�IHticatictinitatm ed€ ram led = �CneEs m a <br /> MW-2 GW r 4 X !X IcelHCL <br /> MW-10 cw 4 11 x IX lcemCL <br /> MW-11 *Y 11hi GW 4 1 X IX lcwHCL <br /> NP-1 610 q 11 , 5Gw 4 it X 1 X IeVHCL <br /> QA GW 1 1� X 1 X icettict <br /> I <br /> Collected by. atemme Co#fector's Signature- <br /> Relinquished by. x Dat4/nime JReceived by; Datamme _ <br /> Relinquished by Datemrne ii �� �� Received by. .txatomme <br /> Method of Shipment- Sample CondWon on Rcpt. <br /> I , <br /> 4 <br />