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Chain of Custody Number: —tzl I FZ_ <br /> Stantee Chain-of Custody Record <br /> Field Office: 077 Sacramento E2 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 40 a r <br /> m (%1 u W M1I <br /> Turnaround Time 24-Hour TAT <br /> IT <br /> WSampler's Name Colin a 93 me g <br /> 20 r m o¢W=o's Signature 1. a 3 , ro .E nSamplerm q m <br /> Comments/ E <br /> o0 <br /> L1 6 d O d O O O N A O d N Q N H d <br /> Sample ID Date Time Matrix x m > m x m m m w . Instructions z <br /> 19109 s4 0( <br /> W ><I X1K I Ot <br /> E)P to v'.3 °3 <br /> P- j:uo <br /> CAUD <br /> m "C J' '.-�Tnerm. ID# <br /> I itIal fN Date © o <br /> Ime Coolant present: (Mo <br /> Special Instructions/Comments pReinquaReceived by: Sam le Recei t <br /> 5 Oxygenates - MtBE, EtBE, DIPE,TBA, TAME Sign Total no. of containers:1,2-DCA= 1,2-dichloroethane Print Chain of custody seals: <br /> EDB = 1,2-Dibromoethane Company Stantec Company Recd in good condition/cold: <br /> TPHo = total petroleum hydrocarbons as motor oil Time jiuo Date ?J4Loj Time Date Conforms to record: <br /> email lab report to damon.brow n@stantec.com, Relinquished by: 6eived b : _0� L <br /> patrick.herrmann@stantec.com and Sign Sign t7—v Client: Statnec <br /> patrick.schiller@stantec.com Print Pion Brown <br /> Company Company Client Phone: (916) 861-0400 <br /> T' Date Time &91J Date So ext. 230 <br /> O9 V5 N V � Date: -F-'f=I -- Page Idf 1 <br />