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CHAIN OF CUSTODY/ANALYSIS REQUEST <br /> Attention Mark Dysert Phone (650)799-9204 Billing(if different? <br /> Company Name Dysert Environmental,Inc. Email environmental. <br /> data@gmail.com Attn:Accounts Payable I <br /> Mailing Address P.O. Box 5608 Mobile Dysort Environmental,Inc. <br /> City,State&Zip San Mateo,CA 94402 P.O.No. (Q P.o.Box 5608 i <br /> Laboratory ANC w( ( Sampler/s lCl San Mateo,CA 94402 <br /> --- ` <br /> Pactiv Packaging,Inc. Pactiv Packaging,Inc. sampling code• -� <br /> Project 4545 Qantas Lane Project 4545 Qantas Lane Pacliv,Jeff <br /> Name Stockton,CA 95206 Location Stockton,CA 95206 <br /> Sample Matrix= Field Notes: <br /> Wastewater <br /> Turn Around <br /> Time=5 Day <br /> ' — U <br /> Sample ID: Date: Time: No.of <br /> 1 Containers C <br /> 1� t.ib.+irixro1 X -- i <br /> I <br /> I <br /> I <br /> 1 <br /> I <br /> I <br /> 'L�.:)�LJ R.ea..aby <br /> C� Additional Mailing Instructions: <br /> ae 1pl y V _ t R<c.�..gbi <br /> ae weu.d br RecCelXvee by Lme 10 <br /> , 0 <br /> Re1,npv1.hedbY I,. Rewivad by v� rime l! eats l+ <br /> Lab Notes: Notes: <br /> 1 Please hold addtl 1L PL NP <br /> V7 <br /> Sample Temperature Upon Receipt in Lal)_ 1 <br /> Dysed Environmental, Inc. Tel:(650) 799-9204 <br /> ELAP/12764 Web:DysedEnvirormlental.coln Page t of 1 <br /> ('419;3: Chain of Custody <br /> Page 1 of 2 <br /> ■ 8of19 <br /> ■ACCUTEST <br /> Cd 1953 """'"'"""" <br />