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0I) <br />585 Emory Street <br />GeoRestoration, Inc. SanJLneA95112.845t� <br />CHAIN OF CUSTODY FORM <br />Facslmile (408) 295.845, <br />Turnaround <br />10 flay 3 day Sarrie day <br />Project ,~tante: C%^ ,r <br />Time: <br />_ 7 day _ 2 day other <br />Project Number C -:i 33- Task. <br />(working days] <br />5 day _ 1 day 1 <br />l D.: <br />� � <br />Project Address. '14 i .v4 V.AL <br />Laboratory:McCain Gell Anal cal Contact Rosa`" <br />P yt= <br />Anal ses Re vested <br />Crab AddresslPhone 1535 Willow Vass Road, Pittsburg, CA $877 252-9262 <br />Project Manager wn.i <br />PM Phone Number At> )15 t- C, OL,Li Sr Email: main georestoration_com <br />Sampler Phone (408) 292-8450 <br />, <br />I <br />Sam le Information Container Information <br />Comments <br />Matrix <br />Field Point Name <br />No. Type Preservative <br />Same as GRI Sample <br />j} <br />Sample ID Lute Time swi water Vapor <br />Id <br />�a i C.+' <br />�-yam <br />1.—•..-...w„ -W .,„.�..... ,«.,., <br />55 r4 l <br />5<s K 4 <br />i Ct woo � <br />— <br />Esc, <br />i <br />.'J irks � • i:.:+ 1 k i k. + <br />�... <br />,.�...,.®..m. <br />.-.. i <br />�'S 354 1.0 It .; k- <br />_...._ <br />m <br />S ',ii A 3. Cw t t ��.3 # <br />� <br />H it :5 kI' <br />EAD CEA fix11F?5 <br />Additional Comments: Invoice to GeoRestoranon, ±nc. and send report is r? �a;r��georestoraton com <br />n VG- >S pg _ <br />... _.-._.. <br />Geotracker EDF <br />7, <br />Relinquished �y� ,''� it. l-�atetTrt e. ?,r f?' <br />Received Bgr <br />� � <br />FaatwTlme f` <br />Relrrtqutshed By `[ . s, .ate ` DateM e <br />Received By <br />�� <br />Relinquished By: Date/Time <br />Received By <br />' <br />Date/Time <br />;Sa-rtpl6 € ondition: tate') Yes No RoNgeraW ? Yes N,) Cooler Temp <br />Transpor*ation Method <br />Page c` <br />Container Type:'V = &G int vtai t_ = _. hW 3MW k>aMe, 5W nit = 5W molititer txsttle. T - hilae tB rta S - siatirs*,S steel, ? tillst`r , <br />Preservative: NCL = I iydrochldna acid N = Nitric acid, C = 4o C; <br />l"U"Ni 11 <br />M <br />