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CHAIN OF CUSTODY/PANALYSIS REQUEST C <br /> Attention Mark Dysert Phone (650) 799-9204 Billing (if different) <br /> Company Name Dysert Environmental, Inc. Email j environmental.data@gmail.com Attn:Accounts Payable <br /> Mailing Address P.O. Box 5608 Mobile I, - Dysert Environmental, Inc. <br /> City, State & Zip San Mateo, CA 94402 P.O. No. P.O. Box 5608 <br /> Laboratory Alpha Samplers San Mateo, CA 94402 <br /> Project In <br /> Pactiv Packaging, Project Inc. i Pactiv Packaging, Inc. Sampling Code= <br /> Name 4545 Qantas Lane Locati ' 4545 Qantas Lane Pactiv,Jeff <br /> on <br /> Stockton, CA 95206 � Stockton, CA 95206 <br /> I <br /> Sample Matrix = Field Notes: <br /> Wastewater , m o <br /> Turn Around In "0 U) 1 <br /> o � <br /> Time = 10 Day - <br /> y3s 1 <br /> Sample 1D: Date: Time: No. of i LL f <br /> n Containers <br /> 2 x 1L PL NP X <br /> i <br /> ,I <br /> f <br /> I <br /> Rclinqulshe b I Received by Tim D a <br /> 0 Additional Mailing Instructions: <br /> Reli ,Q#0� Received by Timei a <br /> Co„n; r <br /> Rclin ulsha Receivadb C ]]meDat �lr_�, CC: <br /> S SS <br /> Relinquished by Re I d b Time <br /> Lab Notes: I Notes: <br /> I <br /> I <br /> sample Temperature Upon Receipt in Lab <br /> Dysert Environmental, Inc. Tel: (650) 799-9204 ' <br /> \ ELAP# 2764 Web: DysertEnvironmental.cot i Page 1 of 1 <br />