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Chain of Custody Number: �o <br /> Stantee Chain-of Custody Record <br /> Field Office: 077 Sacramento 0 Additional documents are attached, and are part of this Record. <br /> Address 3017 Kilgore Road, Suite 100 Job Name: 7-Eleven Store#14113 <br /> Rancho Cordova, CA Location: 3040 W. Benjamin Holt Drive <br /> Stockton, CA <br /> Project# 77EL.14113.28 Task# 0403 Analysis Request <br /> Project Manager Damon Brown <br /> Laboratory Kiff Analytical <br /> W v NY .m W <br /> Turnaround Time 24-Hour TAT <br /> W a ._ ° m <br /> O � � t3 C7 > 00 a u o <br /> Sampler's Name Colin t 17 X <br /> 8 o & o o m ° o <br /> c o • <br /> Samplers Signature m B E m v o > ry U w W <br /> ;6 m o2. l m Comments/ n <br /> o A < E e m 2 E <br /> Sample ID Date Time Matrix = m a a > i w e h ; K w ` Instructions z' <br /> 3�Za <br /> 7_1L(/04 oi tZ <br /> -`t-1 o tz:yo 0 <br /> C_lp- I7 4 is <br /> . CSP-4-LO t:5o tb <br /> Special Instructions/Comments Relinqul Received by: Sample Recei t <br /> 5 Oxygenates - Mi ELBE, DIPE, TBA, TAME Sign Sign Total no.of containers: <br /> 1,2-DCA = 1,2-dichloroethane Print Colin RyAn Print Chain of custody seals: <br /> EDB= 1,2-Dibromoethane Company Stantec ComparSy Recd in good condition/cold: <br /> Ti =total petroleum hydrocarbons as motor oil Time 4'w Date pyTi r�ie Date Conforms to record: <br /> email lab report to damon.brown@stantec.com, Relinquished by, Received ii �L <br /> patrick.herrmann@stantec.com and Sign / Sign ^- Client Statnec <br /> patrick.schiller@stantec.com Print % Print o r f Client Contact: Damon Brown <br /> Company Company __ ,+.- Client Phone: (916) 861-0400 <br /> Time Date Time �osy Date oLo ext. 230 <br /> SECOR CJS IRLC Rev L99 <br /> Date: 2J003 Page_ <br />