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TestAmerica Pleasanton Chain of Custody Records T st <br /> 1220 Quarry Lane <br /> TSE SCPUIP`N ENVIKO-NMENTAL TESTHNU <br /> Pleasanton,CA 94566 7%0 0. S87318 TestAmeriGa Labl <br /> phone 925"484.1919 fax Regulatory Program: ❑DW ❑NPOES El acaA L1Cdier: oratories;l c. <br /> Client Contact Project Manager: Site Contact Q , [;r ,t ©ate: COC No: <br /> Ninyo&Moore I -fellFax: Lab Contact: Carrier: of CDCs <br /> 1956 Webster Street.Suite 400 Analysis Turnaround Time Sampler" <br /> Oakland,CA 946',2 ❑ CALENDAR DAYS ❑ WoR ING DAYS For Lab Use Only: <br /> (510)343-30130 Rhone TAT r.different from Below z Walk-In Client: <br /> (510)343-3001 I FAX ❑ 2 wearsz y Lab Sampling: <br /> Project Name: 1week o <br /> Site: ❑ 2 days a CnJob/SDG No.: <br /> PO# I Iday E 0 r <br /> amp w <br /> e <br /> Sample Sample j Tcomp #of <br /> Sample identification Date Time o=Gmb) Matrix cont LL IT Sample Specific Notes: <br /> J <br /> u _ 1 <br /> ■ <br /> 5/1 --tea �13 ' 'i 1 Z <br /> I <br /> tLls�r?' -�2"Sg4,.dpF3NO3;°' [i4�=ate': ', .;.' <br /> :.. <br /> Possible Hazar Identification: Sample Disposal(A fee may be assessed If samples are retained longer than 1 month) <br /> Are any samples from a listed EPA Hazardous Waste? Please List any EPA Waste Codes for the sample in the <br /> Comments Section ff the lab Is to dispose of tate sample. <br /> ❑Non-Hamrd El Flammable L]51dn fmtant El Poison B ❑Unknown ❑Pewm to client sposal by Lab ❑ hl for Months <br /> Special Instructions/QC Requirements&Comments: Co raS f / fr,y � _S J( _ pp� ��2 p �7 p 2 <br /> )��.� _,�,��, c, C� <br /> O[>/ poOve o > z� <br /> rIfnquished <br /> ntact- ❑I Yes ® No Custody Seal No.: CaalerTernp.( G):Obsd: Goad: Therm ID No. <br /> C m any: Daterrime: Received by: Company: Datel ime: <br /> Dateffime: Deceived by: Company: Date�me: <br /> DaiFlTime: Reoei ed in Laborat ry by. ) r Comp�ny� Date!Time: <br /> Form No.CA-C-WI-002,Rev.4.3,dated 12105/2013 <br /> 720-58738 Chain of Custody <br />