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<br />USKOUil <br />DIETZ ENGINEERING AND CONSTRUCTION, INC. <br />Anatyiei Requested Lab. No. <br />c^f-/7-a^-Cl <br />Priority: Routine CST Expedited Special Q <br />7^ <br />/////)/ <br />C82Qiyq/C^t; <br />Received/ Relinquished by: <br />Received at Laboratory by: <br />Rev. 0'0 <br />Received/ Relinquished by: v\XxW'i <br />Received/ Relinquished by: <br />Laboratory: <br />Carrier: <br />Waybill No.: <br />CHAIN OF CUSTODY / <br />REQUEST FOR ANALYSIS <br />RECORD <br />i > <br />Ct <br />M <br />O <br />s <br />o <br />o s <br />co <br />■o <br />s <br />X <br />a 4> <br />£ 3 <br /><T <br />2 <br />3 <br />i <br />___Company __ <br />£<fC <br />[Vt ArG lyrics I <br />Date Received Time Received Date Relinquished Time Relinquished <br />r- <br />Sample Hazards:. <br />Notes: <br />CUSTODY RECORD <br />Originator: <br />& o <br />rr <br />O <br />;■ <br />« <br />o <br />m <br />Lu <br />LU <br />NJ <br />00CO <br />Print Name Signature <br />//,<X <br />I: <br />Wellhead/ Depth to Date Time <br />Surf. Elev. GW/SampIe Sampled Sampled <br />'I//// <br />Transmit results to office checked below: <br />33233 South Koster Road, Tracy, CA 95304 <br />Voice: (209) 832-2910 Fax; (209) 833-1288 <br /> 1120 Hollywood Ave. No. 3, Oakland, CA 94602 <br />Voice (510) 336-9118 Fax: (510)336-9119 <br />Project: 5^,, <br />Project No.:Project Mgr. <br />Sampling Team:__________ <br />Site Global I.D. No.: <br />Sample Type Field <br />Number Point