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585 Emory Street <br />G66Restoration, Inc. San Jose, ' CA 95110-1822 <br />CHAIN OF CUSTODY FORM <br />Line: (408) 292-8450 <br />Facsimile- (408) 295-8451 <br />Turnaround <br />'Oda 3 day Same. day <br />Project Name. <br />Time: <br />7 day 2day other <br />Project Numot,,! el.�, Task <br />(working days,� <br />5 day 1 day <br />Global I. D <br />Project Address'I <br />-, I L c ,L. , <br />Laboratory: McCarripbell Analytical Contact: Rosa <br />Anal l ses Requested <br />Lab Address/Phone- 1535 Willow Pass Read, Pittsburg, CA (87711 252-W62 <br />Project Manager: —,<+ f�- <br />PIV Phone Number: Email main@georestoration com <br />Sampler. Phone. 14(1.8,) 202-8450 <br />Sample Information Container Information <br />Comments <br />Matrix <br />Field Point Name <br />Type Preservative <br />Same as GRI Sample <br />Sample ID Date Time soi! wa*er Vspar <br />"SCA a I X <br />----------- <br />J- <br />W4D W LAS <br />...... .... <br />. . . . . ........ <br />.......... ..... <br />Additional Comments Invoice to GeoRestoratior. Inc and send report to.'rialn @georestoraton.com <br />Geotracker EDF <br />Relinquished By <br />Received By <br />Date!Time 11 <br />Relinquished By <br />Received By <br />Datei(Time. <br />Relinquished By Date;Time <br />Received By. <br />Datef7irne <br />Simple imple Confton G*Wl Yos___ No Re"eiratea ? Yes _ No cooter Temp <br />TMnsportaticn, Metmod <br />Page ofl-, <br />Container Type: V * 40 nil vias. 1- lir amber borne 600 ml = 500 millititei oom I = tube,,B - Liass S - staiLess sot el P. plastid -4- .,S- A Preservative. HCL r4*0rochiorIc acid N = Nitric acid. C o 4a C <br />