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C <br /> CD <br /> 0 <br /> v <br /> Y c�i < <br /> � y <br /> W c acee Chain of Custody Form <br /> I` Y o Z <br /> A y )C: 1.�O r m <br /> �, z <br /> a 5 MALYTICALSERVICES 4100 Atlas Ct.-Bakersfield,CA 93308-661.327.4911-Fa 6 3 1 18-www.pacelabs.com ai n <br /> a' <br /> r <br /> 5 ciient: Arcadis U.S. Inc project#:30274343.01 "• Page.L_of� � m <br /> o Attn:Dalia Rumani Project Name:Forward Landfill o Comments: <br /> _ Y y See Arcadia Atemmente A and B for VOC and Desolved Metals >Z m <br /> 0 0 Tt Street Address: 18401 Von Karmen Ave,Unit 300 BID# tQ26 Groundwater Monitoring Wells _ t E w rye I <br /> E Disc Metals=Al.Sb,As,Be,Be,Cd,Cr,Co,d,Fe,Mn,Mo,Pb,Hg,Ni,Se.Ag.Tl,Sn,V. <br /> e Satnpler(s)N V 8 v Zn-WRltered p r <br /> D_ City,State,zip: Irvine CA 92612 <br /> o , Printed: 8 a m <br /> N U LL Alw send n s ns to Zine Kamal(ZIna.K—al@a—ft.com).Elena Strom <br /> na. n, phone:805.234.1390 Fax: o 2 E (etana t—Q—ad1s.can),and Kyle Pow.(kpu.Gffihydro.can) <br /> b Email: dalia.rumanl arcadis.com A t m A V Sample Matrix Result Request *'Surcharge 0 <br /> p Y g m J STD -5 Day- -1 4 Day- m <br /> .� ne Ds;') <br /> W ° Q Work Order#: �0 00 Z 4z m s m m <br /> x s $ a Y > g > 3 3 Day" 2 Day" 7 Day" <br /> m a. U g x „ Rush requests must be approved o <br /> CDa O v 0 F o i5 12 $ o A 0 3 other Notes <br /> Description CL <br /> 2 o <br /> A -12 - <br /> w -13 Q o <br /> 0 <br /> 0 � <br /> x -IN <br /> _ - <br /> -11� Z G <br /> Z S <br /> CD <br /> -1� - ^'ry 1u <br /> o <br /> u <br /> o <br /> Ch <br /> Wow <br /> �20 2 <br /> 7 -Z <br /> kfl x y Ig IX <br /> add s <br /> -23 — Z <br /> Uj <br /> C, o ' ❑Same as above EDF Required Geotndcer Yes []No Global ID <br /> °o <br /> N a � client: Forward Landfill <br /> � � 1.Relin wished 8 Date Time 1.Received B Date Time <br /> q Y <br /> Address:.9999 S. Austin Road ------------ ---- -�� �,`M1C �(r•0 <br /> System# 2.Relinquished By Date Time 2.Received By Date Time <br /> o city: Manteca —State�A zip 9 y o - (Needed for CLIP) 1A <br /> -�� W z <br /> aAttn: GIS/Key 0 Well Star 0 3.Relinquished By Date Time 3.Received By Date Tame, <br /> b P.O.#: <br /> n, 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 <br /> t° n of containing radioactive material above background levels will not be accepted and will be returned to client. <br /> REV 1212021 <br /> 0 <br /> ID o <br /> v <br /> Q) <br /> W <br /> rn <br /> O <br /> A <br /> 4 <br />