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c, <br /> rn <br /> m <br /> a <br /> a <br /> 0 <br /> v <br /> ?CG� 1{ �, Chain of Custody Form <br /> ANALVTICaL SERVICES 4100 Atlas Cf.-Bakersfield,CA 93308-661.327.4911-Fax:561.327.1918-www.pacelabs.com <br /> :�-)c ent: Arcadis U.S. Inc Proiect 4:30274343.01 Page of <br /> Attn:Dalia Rumani Project Name:Forward Landfill o = g Comments: v a <br /> U Z y v rea j Ses Ad,s Aecnmen als A and B for VOC and 13,—Ned Metals „p p <br /> Street Address: 18401 Von Karmen Ave,Unit 300 BID# 1Q26 Groundwater Monitoring Wells <br /> E Oiss Metals=A.Sb.As,Ba,Be,Cd,Cr,Co.C,Fe.Mn,Mo,Pb,Hg,Ni,Se.Ag,n.Sn,V. S <br /> City, Zip: Sampler(s)Nam�ry„ � o C c o "o D-Not Rllered <br /> y p Irvine, CA 92612 Printed: _ �%'v' N o a) t ; o 0 2 <br /> U LL _ Also send resul45 to Zna Kemal(Zina.Kamai^garcad�s.cpmt.Elena Strom y " <br /> Phone:805.234.1390 Fax: {-.� o Z m c E (elcaaslronK arcadls.com),andKyePower(kp ower@bihydro.com) i v a <br /> Email: dalia.rumani@arcadis.com o Z s B Sample Matrix Result Request -Surcharge 0 333 <br /> Z G $ -- o Y �0 2 `o m m i . STD r-5 Day- -1 4 Day- ? � 3 <br /> N z Y m a my l la ors) <br /> Work Order#: � m o <br /> ? t g > m 3 Day" --1 2 Day- -j 1 Day- <br /> D. {j Q o N y N Rush requests must be approved r' <br /> DescriptionQ _ to N _ v C p h <br /> ampled Sampled > c� W o o F O n rn o a other Notes N <br /> c x A x <br /> is _i o LL <br /> .0 I <br /> Q o � <br /> M ; lelwk(Ad — ��-- <br /> N <br /> a <br /> >�o <br /> Co co <br /> � o <br /> O — Q ° co <br /> I o 0) <br /> 0 f a U <br /> or <br /> E .� <br /> G <br /> U. y Y <br /> i/ (o <br /> •� FFF 1� � aU <br /> i r EDF Requ''d otr ker Global ID' ° m <br /> y i d Some as above []yes ❑No o m <br /> e o ° Client: Forward Landfill a <br /> \ Q t.Reli is B Date Time 1.Received By Date Time o <br /> y Address:9999 S. Austin Road ----------- ----- <br /> Uz R city: Manteca State CA-Zip 95336 system# i linquished By ate Time 2.Received By Date Time c <br /> .LA � �` T, i <br /> w t (Needed forGLIP • 1 �a� {7. d' (,t'(1�C,4/3t .'.,r 4?tit; J, t .. <br /> \ y 'a Attn: Q$ValdO Cordero-209-235-9622 a.Relinquished By Date Time 3.Received By Date Time r <br /> M Q GISYKey 0 Well star❑ <br /> rim t"n P.O.#: <br /> Qz 7 <br /> f V Pace Analytical Bakersfield does not accept samples containing radioactive material above background levels. Samples containing radioactive material must be disclosed prior to receipt.Any samples suspected a N <br /> Vo C of containing radioactive material above background levels will not be accepted and will be returned to client. N <br /> > a <br /> Z o <br /> w t) O <br /> 0 <br /> 0 <br /> 0 <br /> a <br /> 0 <br /> lY <br />