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RECEIVED RX929!

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OF POSSESSION<br />

377-5( 5 1 0<br />

Relinquished By/Rtmoved From<br />

J<br />

FH-Central Plateau P roject CHAIN OF CUSTODY/SAMPLE ANALYSIS REQUEST F03-006-65 I Pella 1 of 1<br />

Collector Company Contact Telephone No. Project Coo rdioator<br />

Johi msen/PopdKister LC Hulsuom 373-3928 'TRENT. Sl<br />

Project Resigna tion Sampling Loca tion<br />

200-PW-2/200-P W-4 OU - Borehole Soil Sampling 216-A-37 (C4106); (37.5'-40')<br />

From<br />

By woo Emm<br />

Relinquished By/Removed Fran<br />

LABORATORY Received By<br />

SECTION<br />

FINAL SAMPLE DisPoSid Merl<br />

DISPOSITION<br />

)<br />

1<br />

-A -4in<br />

Date/fine f<br />

4.<br />

Drtc/fime<br />

0,5<br />

Daterrime<br />

I --A Personnel not available to<br />

relinquish samples front the 3728<br />

^'9Yz Refk on cT l_L/01<br />

Tit le<br />

repot bah kerosene and diesel moat cconapoounds from<br />

Disposed By<br />

SA006<br />

Ice Cheat No / Field Logbook No. COA Method of Shipment<br />

/<br />

M L 9.6 O s Y HNF-14.3361 117504ES10 Federal Express<br />

Shipped To rz 45^-(-J Dffsite Property No.!1 ,n ^D<br />

A0<br />

POSSIBLE SAMPLE HAZARDS/REMARKS<br />

Special Handling and/or Storage<br />

SAMPLE ANALYSIS<br />

Preserva tion<br />

Type of Con tainer<br />

No. of Containers)<br />

Volume<br />

Sample Sample Time<br />

Bl OW82 SOIL<br />

SHI-EE-011 (03101/2002)<br />

Cool4C Cod 4C Cod 4C Nam Nam<br />

'C<br />

2 0<br />

aO aG<br />

1 1 I 1<br />

120mL 60m1. 120mL 60m1. 60mL<br />

CN.,A. NOVNO3- Qlacreare- sees)' T66--HI<br />

Hex-7195 353.2 4 13.1 pedd<br />

P rice Code 814 Data Turnarou<br />

Air Quality El<br />

Bill of Lading/Air Bill No. ^ — ^^^<br />

a<br />

/1 21& 7 Matrix<br />

, lea6rbee+4' •• The labomto ry is to<br />

i-D analysis.tl^ SE^Yas^<br />

SOSSda<br />

1 1/O f<br />

DatelT"mre<br />

Date/Time<br />

45 Days<br />

n-nws<br />

W - W'"'<br />

DS-<br />

OS-nnw Sd;N<br />

m.o,w r+ww<br />

r-r<br />

wo-w;R<br />

e-fie<br />

9.yyna m<br />

x-aw I

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