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M <br />TestAmerica West Sacramento Test�merica <br />B80 Riverside Parkway Chain of Custody Record <br />West Sacramento CA 95605 <br />Phone (916)373-5600 <br />>_ - — — s_a_s-� 1�-rY:..It1M►-'�:;�.S=.w"Js=�►-� 1. <br />Sample! <br />Lab PM <br />Ca rte fa[1mq No,i <br />COC No <br />Client Information <br />Brian Branscum <br />Wagner. Heather <br />(;hent Contact <br />1j916) <br />Phore <br />E -Mar <br />Page <br />Amanda Magee <br />281-8361 <br />heather wagnerCatestamericainc com <br />Page of <br />Ccmcary. <br />.Mb a <br />Stantec Consulting Services Inc <br />Analysis Requested <br />Aodresr. <br />Due Dam Requested: <br />Preservation Codes: <br />3875 Atherton Road <br />o <br />n <br />o <br />A . HCL M - Hemle <br />B - I'LaOH N, Nonn <br />C ly <br />TAT Requested (days): <br />Rocklin <br />24 H R <br />n <br />r" <br />C - Zn Ace!ate 0 - AsNa02 <br />D - Nitric Acrd P - Na204S <br />State. Z'P <br />CA. 95765 <br />s <br />F <br />F-NaHSO40 <br />E - FAPOHR - Na252SOg <br />Phone <br />PO # <br />(916) 472-3985 <br />'o <br />Zm <br />0 <br />m <br />w <br />o <br />0 - Arncnla, S - 1`12504 <br />H - Ascorbic AGM T - TSP DodecahyMratn <br />I • Ice U • Acetone <br />Email. <br />WO # <br />rnarna^aOPn(B'�ntfr,__n <br />W0230335 <br />o <br />} <br />0 <br />O <br />n <br />o <br />< <br />m <br />H <br />C <br />J - Dl Water V - MCRA <br />K,EDTAW - ph 4•5 <br />Pro1Pc! Name <br />Protect # <br />Stantec-CA-non-ENEOS <br />v <br />E <br />o <br />i <br />m <br />° <br />w" <br />a <br />c <br />o <br />t - EDA z•olne:(spnrry) <br />Other: <br />Srte <br />SSOW#. <br />7 -Eleven #19976A <br />rn <br />m <br />m <br />u <br />m <br />a <br />5 <br />m <br />`o <br />Sample <br />Matrix <br />u <br />i <br />o <br />< <br />g <br />A <br />w <br />a <br />E <br />E <br />Type <br />( w�..,« <br />...,m, <br />= <br />"- <br />� <br />w <br />w <br />w <br />d <br />n <br />L <br />Tc <br />u <br />w <br />.Y <br />Z <br />Sample <br />(G=Comp, <br />w-7— <br />Z-7— <br />v <br />O <br />U <br />Q <br />L <br />U <br />1 <br />'Fj <br />Sample Identification <br />Sample Date <br />Time <br />G=grab) <br />e1-T..u..A— <br />ii <br />a` <br />0 <br />o <br />o <br />z' <br />a <br />� <br />� <br />1- <br />S ectal In structionstNote: <br />Preservation Code <br />i2 1. IZa <br />I q35(� <br />D <br />l� <br />S6 -4 <br />1,510 <br />Sg <br />1502- <br />1 <br />h <br />1 <br />0O <br />320-24082 Chain of Custody <br />Sample Disposal (A lee may be assessed i/ samples aOetained longer than f month) <br />Possible Hazard ldejtii oration <br />C O O <] <br />Non Skin Poison B <br />-Hazard tIammable frolant UnAnown Radiological <br />Return To Client Disposal By Lat) Archive For Months <br />Deliverable Requested: I. 11, III. IV. Other (speafy) II <br />Special Instruchons/0C Requirements. Email lab report to amanda mageeCstantec.com: <br />patrick mcconnell@stanlec com, deborah Ilchtenbergerastaniec.com, eM41t20c�c' Lead, cam <br />Empty Kit Relinqui ed by: Dale'. Time Method br Shpr rn! <br />Re;rngwshed by7 <br />Datefrime l y <br />Company <br />Rnterved by <br />DaleJ me <br />IC' <br />Company ^. <br />(Z t,J(c, 1140 <br />S�MvIrG <br />f <br />—LLcn <br />1 <br />Rei,ngwxhed by <br />nate?ime <br />Cur.,pany <br />Received by -1 Id - 11-7 <br />DaleMme <br />Company - <br />Re'!nnurshel by <br />Date•Time <br />Compan, <br />Recer,ed by <br />Dale.'Tlme <br />Company <br />Custody Seals Intact: <br />Custody Seal No <br />Cooter Tempniawre(s)"r- and Othnr Remark, <br />Yes , No <br />>_ - — — s_a_s-� 1�-rY:..It1M►-'�:;�.S=.w"Js=�►-� 1. <br />