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S L OIL COMPANY AIN OF CUSTODY RECORD Dare: /z q® <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No. `����2 Y- T3 Page of <br /> Site Address: Analysis Required LAB: <br /> 3725 S. Tracy Blvd Tracy Y a <br /> W ICk: �.� CHECK ONE r1I IOX ONLY CT/D1 TURN AROUND TIME <br /> ' 2oa-7s8�-o9a1 +; <br /> }� Gw Fbnllomg 30 "iT <br /> Shell Engineer: Phone No • (510) z1hoir <br /> Alex Perez 675-6168 -4 HeInvrrllgdlon 11 Ie h.. ❑ <br /> Fax #I: - o <br /> Consultant Name & Address: g souclo„uy/n1r�,a1 ❑ z�Jz ISdays X-nU+ormaO <br /> Blaine Tech Services, Inc. Co w°r•r <br /> 1680 Rogers Ave. San .Tose CA 95112 S clur>pu�rdl ❑ u4a <br /> Consultant Contact. Phone <br /> «0$) ^ Q3 N m Soil/ALRrm oriyr ❑ "S2 <br /> Fran Thie Fax 573-7771 to `� a�M <br /> d a NOTE NoNty lab nr <br /> Comments N Rrm orgy, Zoon as o ;AT r o[ <br /> A' o ALn <br /> e M 0 �S3 24/48ee hn ;AT <br /> mow.. o O u] <br /> LL <br /> Sampled by. '1' '�' n n "° c N � } r <br /> I/ p m to v► d O $ y LA O m UST AGENCY <br /> Printed Name: w w IL °1 a n d n a MATERIAL. LE <br /> x E o CONDITION/ <br /> No of x u, ° in ° � o v o DESCRIPTION <br /> Sample ID Dale Sludge Soil Wolof Alt canis r m ►� [� ¢ U 0 COMMENTS <br /> #MvJ - )A f t�zy x � _ C( <br /> A <br /> Relln i bffure), Printed blame Dafa,�� 2S w Rocoived(signolure). Prinled Name, Daie r . <br /> S Sr+'t Time t11S <br /> Rellrtqul ure) Printed Name, Dale ecetved (dgnaluro) Printed ama, Dale. <br /> r Time — m 1 <br /> Rellnqulshed By(sl nature Printed Name Dale Roceiv� od (signature). PrInted ame` Date, 11—ID5 <br /> mer �. Time _D <br /> n.+ao. 14C. <br />