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40 <br /> ARCADIS 1D4: CHAIN OF CUSTODY & LABORATORY Lab Work Order# <br /> ANALYSIS REQUEST FORM Page Lof� <br /> Contecl 6 Company Neme: T lephoro: - Preaenetive ,�L� Keys <br /> Scott HackmanF d(� preservation Key. Container Information Key: <br /> rHO, 1.B. CL2. 10ml V[al <br /> L Amber <br /> Addrw: F_ /d A.Cent t— <br /> m C.HNO, -3. 250 ml Plastk <br /> m <br /> W t T D.NaOH 4. 500 ml Plastic <br /> v J E. None 5. Encore. <br /> "" 4ee vp E malAddma.: PARAMETER ANALYSIS&METHOD <br /> a F.-Other. 6. 2 oz.Glass <br /> e' Roseville, CA scott.hackman@arcadis.com 4 G:Other.- T: 4—Glass <br /> B. 6 oz.Glass <br /> Profed N.-IL—tion(CRY.sralek Pm)ad r. ' H.Other. 9. Other <br /> French Camp,CA <br /> Mother. <br /> samplers Pdnled Nemo: samplers Sig- Matrtx Key- <br /> Kevin <br /> eyKale ReduadSO-Soil SE-Sediment NL-NAPL/00 <br /> W-Water SL-Sludge SW-Sample Wipe <br /> Sam �e ID Collection Type V) Matrix a T-Tissue A-Air Other. <br /> p Data tura comp Gran 11/REMARKS <br /> L <br /> fia i uZ. <br /> WO# 10499008 <br /> In <br /> 0499008 <br /> Spacial Instructions/Comments: ❑Special QA/QC InstructiorisH: <br /> Laboratory Information and Receipt Relinquished By Received By Relinquished By Laboratory Re"Wed By <br /> tab Na �G Cooler Custody.Seal(✓) Prt W Name: PH,,4.d Nano: Prided Nemo: Purred Nana: <br /> Cooler packed with Ice ❑-Intact ❑-Not Intact sle"ecrre: sgnanae: , sgnature: <br /> � sgnei,re: <br /> pearyrumdamdr�ewrem,ne: �2 Sample Receipt Fm: P.nvcwa caner F � y <br /> SNppig cllnll1: Condition/Cooler Temp: oaermTj_Ir�! q (( 7, oa'�"ne DST Dammme: <br /> N 11 ( I' <br /> o zoraoaz/cdc AR Farm e1.12—IM7 Distribution: WHITE—Laboratory retums with results YELLOW—Lab copy INK Retained by ARCADIS <br /> 7 ' 6.e% <br />