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TestAmerica Pleasanton Chain of Custody Record O�/ U 7� /17TestAmerica <br /> 1220 Quarry Lane <br /> THE LEADER IN ENVIRONMENTAL TESTING <br /> Pleasanton, CA 94566 <br /> phone 925.484.1919 fax Regulatory Program: ❑ DW ❑ NPDES ❑ RCRA Q Groundwater TestAmerica Laboratories, Inc. <br /> Client Contact Project Manager: Daniela Hamann-Nazaroff Site Contact: Brian Ukestad Date: 3/2012023 COC No, <br /> WSP Tel/Fax: 510-663-4225 Lab Contact: Micah Smith Carrier: TAL 1 of 1 COCs <br /> 1670 Corporate Circle, Suite 101 Analysis Turnaround Time Sampler: Brian Ukestad <br /> Petaluma, CA 94954 ❑ CALENDAR DAYS WORKING DAYS For Lab Use Only: <br /> N <br /> (707) 793-3866 Phone TAT if different from Below z M Walk-in Client: <br /> (707) 793-3900 FAX ❑ 2 weeks Z a 2 Lab Sampling: <br /> Project Name: Olin Tracy ❑ I week r o O M a s <br /> Site: Trac n <br /> y ❑ 2 days a M Jab/ SDG No.: <br /> P O# (Invoice to Olin) ❑ I day E 0 „ �, m a o <br /> m ++ �+ Q a- <br /> le e N f W W v <br /> '13 o 0 0o o 11- <br /> Sample Sample (�coop #of D i V , <br /> Sample Identification Date Time G=Grab) Matrix Cont. U. a. a. IL z 010 Sample Specific Notes: <br /> MW-5 3117123 19:42 G GW 3 X <br /> MW-9 3/17123 18:36 G GW 3 X <br /> MW-10 3117123 17:48 G GW 3 X <br /> MW-11 3117/23 16:51 G GW 3 M s X <br /> MW-12 3/17/23 16:03 G GW 3 X <br /> MW-13 3117123 12A8 G GW 3 X <br /> MW-14 3117123 1148 G GW 3 X <br /> MW-15 3117/23 14:45 G GW 3 X <br /> MW-15-DUP 3/17/23 14:45 G GW 3 X <br /> Trip Blank 3/17/23 12:00 2 X <br /> Preservation Used: 1= Ice, 2= HCI; 3= H2SO4; 4=HNO3; 5=NaOH; 6= Other 1 <br /> Possible Hazard 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 if the lab is to dispose of the sample. <br /> ❑✓ Non-Hazard ❑ Flammable ❑Skin Irritant ❑ Poison B ❑unknown ❑ Return to Client Q Disposal by Lab ❑Archive for Months <br /> Special Instructions/QC Requirements & Comments: <br /> Custody Seals Intact: ❑ Yes ❑ No Custody Seal No.: lCooler Temp. ( C): Obs'd: Corr'd: Therm ID No,: <br /> Relinquished b Company: Date/Time'. Re by: Company: Dat rfl : <br /> Relinquished by Company: Date/Time: ceiv by: Company: ate ime: <br /> Relinquished by: Company. Date[Time: Received in Laboratory by: Company. DatelTime: <br /> �� fJ Form No. CA-C-WI-002, Rev. 4.3, dated 1210512013 <br />