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"B orllontal 3083 Gold Canal Drlve r WINDE 2 �Y <br /> Lab Ples Rancho Cordova W M0 M M ME R <br /> 5670 COMPLL7C <br /> Phone 9 61852-6600 CHAIN CSF CUSTODY RECORD Q 5 2 2 INSWCIION$ <br /> � W Fax 916/852-7292 <br /> (omShip To a t t�` ProjectName: l L�f= f �� �r l FOR LABORATORY USE ONLY Analyt cal Methods <br /> _ <br /> 4131 <br /> 1 Q� <br /> Laboratory Po�ect# 413 2 Lon MethodAddress: Project Number 4132 Short <br /> Method <br /> Storage Refrigerator ID4161 Long Method <br /> Project Location: (State) ` " " Storage Freezer ID 4201 shun Method <br /> 5oz z <br /> Sampler Name �- ignature PPE Worn 1n Field 503E <br /> 5031 <br /> 5242 <br /> Rel bed By / /' Date/lReceived By th f S tlShtpment I D Date/Pime 601 <br /> �� C 4 602 <br /> # Relinquished By Date/time v yor Method of a ent/Shipment I D �a A tefrun 1 f� spe <br /> �J/�] 610 <br /> 624 <br /> Relinquished By Daterriime Received By or Meihod ent!D Date/I une 625 <br /> 6010 <br /> 8015 <br /> Sample Disposal Level of n 1 a❑2 ❑3 ❑4 ❑5 ❑6A :�- iNALYSES REQUESTED 80020 Mod <br /> (check one) QC � 6021 <br /> (sec Side 2) ❑66 ❑6C ❑6D ❑6E ❑7 Write m 8090 <br /> 'i Analysts Method 6100 <br /> Laboratory Standard <br /> 8150 <br /> L] Other SAMPLE INFORMATION _ 9270 <br /> t 8310 <br /> s t = Acidity <br /> s Description Conts Alkalndy <br /> ainer{ ) <br /> FOR LABORATORY USF,ONI Y ` BTEx <br /> Sample ID Matrix Pres Chloride <br /> Lab 1D Number Date Tune Locator Depth # Type Type Type TAT x CLP (see Side 2) <br /> V f COD <br /> Lf,.i�`/ j �Vp /�' ' �� / O l' 1Lr f I Co Color <br /> 2 0 %f 6 L/� fr r / CorrosNAy <br /> Cyanide <br /> Flashpoint <br /> 3 Fluoride <br /> 4 Heeral ChroMineral <br /> m <br /> xm u <br /> Ion Balance <br /> 5 Metals(write speal c <br /> metal 8 method 4) <br /> 6 Metals Ism o <br /> 7 Mew,PP <br /> Metals TAIe 22 <br /> TTLC Level <br /> 8 STLC Level <br /> Isea Side 2► <br /> morale <br /> 9 Wide <br /> Odor <br /> to Org Lead <br /> Org Mercury <br /> Special Instructions/Comments Percent Moisture <br /> Pe Container Types A=1 Liter Amber �TAT{Analytical Tum Around Time) Parcenl Solid <br /> B=Brass Tube, C=Cassette C-.�24.hours' 2=48 hours Perchlorate <br /> G=Glash 7arJ/'/ P=Polyethylene 3=1 week 4=2 weeks phosphates <br /> r'0=0ther61' V=Voa Vial 0=Other Phoq shorus <br /> SulfSulfides <br /> 'FOR LABORATORY USE ONLY Sample Condition Upon Receipt SEND DOCUMENTATION ASVD RESULTS TO(Check one) TCLVOA <br /> �! a1( f " /,`r ti f 7 Semrvoa <br /> El Project Manager/Office - Metals <br /> Pesticide <br /> { ❑ Client Name TDs <br /> Tolaf Hardness <br /> l / I <br /> Company Talal Solids <br /> t <br /> _., r. f rPwO <br /> Address r r - , r !+ T <br /> PHiG rsSss <br /> Turbidity <br /> Phone FAX Spe,;riy Total or Drssolved <br />