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Test-America West Sacramento <br /> 680 Riverside Parkway Chain of Custody Record TestAmedca <br /> West Sacramento,CA 95605 <br /> Phone(916)373-5600 <br /> Sample, Lab PM Garner Tracking Nota COC No <br /> Client Information Brian Branscum Wagner.Heather <br /> rent Contact Phone: E-Mar. Page <br /> Amanda Magee (916)281-8361 heather wagner@testamericainc.com Page of <br /> Company. Job d <br /> Stantec Consulting Services Inc Analysis Requested <br /> Address Due Date Requested: <br /> Preservation Codes <br /> 3875 Atherton Road <br /> A-HCL M-ykxane <br /> C-ly TAT Requested(days) 8-NaOH N-None <br /> Rocklin 24 H R n C-Zn Acetate o-A$NvO2 <br /> State.Lp W D-Nitric Acid P-Na204S <br /> CA.95765 s F.�Oa R:Na2�25 5303 <br /> Phone. POS � <br /> G-Arnchbr S-H2SO4 <br /> Email 472-3985 =o m H-Ascorbic Acid T-TSP Dodecanydrat• <br /> Email WO# a 1-Ics ll-Acetone <br /> amar.aa mage d2stantec.com W0230335 ° Z v; m -Dlwate V-MCAA <br /> Protect Name: Proton is i c o < $ K-EDTA W-oh 4.5 <br /> Stantec-CA-non-ENFOSM v i AI EDA 7 orr'er(specify) <br /> m i $ � <br /> Site SSOW# E m m w o Omer <br /> m m W < <br /> 7-Eleven#19976 m in mmp $ 9 n m o <br /> Sample Matrix in 4 < < A v w n <br /> Type LL w <br /> S.m,e qy c V V Z <br /> Sample (C=Comp, ..u.uu u t O U Q C- Q A <br /> a On a <br /> Sample Identification Sam le Date Time G=grab) er.rw,.A—).a n. 0 > o" z s ° i°- Special InstrucBonslNotu <br /> Sv <br /> Preservation Code <br /> (ten S�- 146110 14la j \1 1. - <br /> s(S-�} ►510 <br /> O <br /> 56-5 15oZ ►, <br /> sg- i b <br /> 320-24082 Chain of Custody <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than t month) <br /> 1=Non-Hazard 0 Flammable Skin Irritant Poison a Unk,, :wi Radiological i=Return To Client =Disposal By Lab I--] Archive For Months <br /> Deliverable Requested:I,11,III.IV.Other(specify):II Special Instructions/QC Requirements Email lab report to amanda.magee@stanlec.com: <br /> patrick.mcconnell@stantec.com,deborah.lichtenberger@stantec.com;emanZOtlil$' <br /> Empty Kit Relingw ed by: Date: Time: Wthod of Shipment <br /> _ Reinginsned by ` Dateffens / �! 'l 1 CoCompany Recanted by � Daierrme. ``/ C Company <br /> N W _Il� rlrvr/C� cV <br /> 03 Relinquished by'. DateMnw Company Received by Daterr"me Company <br /> N <br /> Relinquished by DaterTene Company Received by Daien-ene Company <br /> Custody Seals Intact Cuslody Seal No Cooler Temperatures)"C and Other Remarks' <br /> Yes , No <br />