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DIEx'Z ENGINEERING AND CONSTRUCTION, INC. tel- Z-f <br /> Transmit results to office checked below. CHAIN OF CUSTODY <br /> REQUEST FOR ANALYSIS <br /> a IS <br /> 33233 South Koster Road,Tracy, CA 95304 <br /> Voice: (209)832-2910 Fax: (209)833-1288 RECORD <br /> ❑ 1120 Hollywood Ave.No. 3, Oakland, CA 94602 1I <br /> Voice(SIO)336.9118 Fax; (510)336-9119 laboratory. .p-b-1 <br /> Carder: <br /> Pro)eat: Waybill No.: <br /> Pro)eot No.; Pro)eot Mgr. <br /> Sampling Team; <br /> Site Global I.D. No.: <br /> Sam pie Type Field 'Wellhead/ Dopth to Date Time Annlyses Requested Lah.No. <br /> Number P011# SurE Elev. GW/bmple Sampled Sampled <br /> LEU ch <br /> �r <br /> N <br /> d <br /> 'C <br /> O <br /> a <br /> N <br /> J <br /> A <br /> V <br /> 4 ' <br /> P <br /> V <br /> i <br /> Sample Hazards: Prlorlty: Routine 1K Expedited ❑ Special ❑ <br /> Notes: •�v — � [.o �i , <br /> CUSTO.D R—ECORD Print Nance Company DeteReceived Time Received Date Rel' ui Ti:ae Refin wished Si true <br /> originator: <br /> Received!Reliaqutshed by70� Z - <br /> f Z- <br /> Received/Relinquished by: , <br /> a Received!Relinquished by: <br /> m <br /> M <br /> N Received at Laboratory by: <br /> ry <br /> m <br />