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N <br />con <br />N <br />M <br />O <br />N <br />Co <br />N <br />N <br />CD <br />M <br />TestAmerica West Sacramento <br />880 Riverside Parkway <br />West Sacramento CA 95605 <br />Phone(916)373.5600 <br />Chain of Custody Record <br />TestAmerica <br />Sa^�ple� <br />Lr�b PM <br />Carrier Tracking Not, I <br />COC No <br />Client Information <br />Brian Branscum <br />Wagner, Heather <br />O'CrIl Conlan <br />Pnrre <br />E-tAa <br />Page <br />Amanda Magee <br />(916) 281-8361 <br />heather wagner(ftteslamencainc com <br />Page of <br />CcmC'any <br />Jn44 <br />Stanlec Consulting Services Inc <br />Analysis Requested <br />Addres- <br />Due Date Requested: <br />Preservation Codes: <br />3875 Atherton Road <br />m <br />$ <br />n <br />A - HCL kt - He, awe <br />8 - Na0H N - None <br />f ly <br />AT Requested (days). <br />lin <br />Rate <br />24 HR <br />w <br />C - Zn Ace!ato O - AsNa02 <br />D - Nrtnc Acid P - Na204S <br />Zi <br />Zip <br />State. Z <br />CA. 95765 <br />w <br />F <br />E-NaHSO4 0-Na2S03 <br />F - I.wOH R - Nd2S2SO' <br />Phone <br />PO » <br />(916) 472-3985 <br />o <br />Z <br />mH <br />t- <br />w <br />m <br />G - Amchla S • 112504 <br />- Ascortnc Ac,d T - TSP DodecahydratP <br />I • ke U • Acetnne <br />Emad. <br />WO» <br />march ^ aoee a ;tarter_ c= <br />W0230335 <br />Z° <br />W <br />m <br />m <br />J - DI Viae V - h1CAA <br />K - EDTA W -Oh 4-5 <br />POI! Nam <br />Prier+. » <br />S-non <br />r1m <br />E <br />o <br />w <br />b <br />w <br />I-EDA -Others <br />pntantec-CA tyi <br />Oihec <br />Srte <br />ti50W» <br />7 -Eleven #19976 <br />y <br />o <br />tn <br />o$ <br />m <br />W <br />m <br />a <br />(L <br />5 <br />a <br />a <br />o <br />Sample <br />Matrix <br />o <br />a <br />w <br />d <br />b <br />n <br />^ <br />D <br />Sample <br />(C=tomo. <br />M <br />2 <br />o <br />v <br />o <br />n <br />L <br />4 <br />Z <br />Sample Identification <br />Sample Date <br />Time <br />G= rab <br />ar.T. A... <br />LZ <br />n <br />u <br />° <br />o <br />i <br />i <br />t°- <br />S ecial In structionslNote: <br />Preservation Code <br />SFO ✓ <br />1 ZI41% <br />1435 <br />i <br />%� <br />I <br />sg -5 <br />1502 <br />320-24082 Chain of Custody <br />Sample Disposal (A fee may be assessed if samples are retained longer than 1 month) <br />Possible Hazard Identification <br />0 <br />Non -Hazard Flammable Skin Irritant Polsgn B Unknown Radiological <br />Return Tn Client Disposal By Lab Archive For Months <br />Deliverable Requested I. Il, III IV. Other*specity) 11 - <br />Special Instructions/0C Requirements. Email lab report to amanda magee@stanlec.com: <br />JJ <br />palrick mcconnellirstantec com, deborah lichtenberger&slantec.com; ernari-Lc4j 6 QF�i ror+n <br />Empty Kit Relingw ed by:Date Time Method er Sh Amen! <br />•�_ <br />Re:rrOuahed by <br />� <br />DateR�n+e <br />pan <br />Comy <br />Rncewed br �( <br />Daie-ircne <br />Ca"any l <br />_: _��, 17L0 <br />1 I <br />Relnqur..hed coy <br />Datea-e <br />G —panv <br />Recewed by -� [�,:� <br />Da!e'T,me <br />company <br />Re:mhM by <br />Date.Tim, <br />Com. any <br />Recer,ed by <br />Dain,Time <br />Compamt <br />Custody Seals Intact: <br />Custody Seal No <br />Cooler Temonratwe(s) °C and Other Remarks <br />Yes % No <br />