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TestAmerica West Sacramento <br /> 880 RiversideParKway Chain of Custody Record TestAmedca <br /> West Sacramento.CA 95605 <br /> Pnone 916 373-5600 <br /> Sampler Lao PM a^e 'rac+�g N-is1 COC No <br /> Client Information Brian Branscum Wagner.Heather <br /> C+e�!Coriac, Phone E•M•e Pape <br /> AmarlOe Magee 1(916)281-8361 heather wag ner@ testamenceinc com Page of <br /> Company Joo a <br /> Stantec Consulting Services Inc Analysis Rec uested <br /> Address Due Date Requested: Preservation Codes. <br /> 3875 Atherton Road A HCL M-He.ane <br /> City TAT Requested(days). 9-N80H N•Nor4 <br /> Rocklin 24 H R w C Zn Acetate O-AsNs02 <br /> State.Zp 0,N-trc Aad P-Na204S <br /> CA.95765 w E NaHSO4 0-Na2SO3 <br /> Phone PO e F ^-MOOM R-Ns2S2SO3 <br /> G-Anchlor S-1-12SO4 <br /> (916)472-3985 a ul m H-Asoorec Add T-TSP Dooecaryaete <br /> Emad WON m i•lu U-Acetone <br /> W0230336 v m C J DI Water V-MCA <br /> Protect Nae ProjW 0 j o b < K-EDTA W-ph 4.S <br /> Name <br /> Stantec-CA-non-ENFOS c a o W < D EDA z-oatsr(+»rM <br /> N c c <br /> Site SSOWNE .e w ov Other: <br /> Go <br /> 7-Eleven tt19978 4v) m$ omS y o w 5 <br /> Sample Matrix m a a d R g E <br /> Type w � c g z <br /> Sample (C-comp, o-ee ion, t o p w <br /> Sam le Identification Sam le Date Time G- rob) eT-T�.-.r LL as u > o i I ial Instructions/Note: <br /> O Preservation Code <br /> CD 12,14/1fj JI(C) G S x x x x x x x 1 * � tE 1tl4{iJt? Soil <br /> N Iwl 5 u [ t <br /> ! Illli �� <br /> 320-24364 Chain of Custody <br /> Possible Hazard Identification Sam le,Disposal(A li Rtayba assessed if samples are retained longer than 1 month) <br /> Non Hazara —Fiammalvc S4,n,r,Ianr Poison a L Unknown Radiological Return To Client Disposal By Lao — Archive For _ Months <br /> Del verao!e Requested i II III Iv Other isoectyi II Special Instructions/GC Requirements: Email lab report to amanda magee@stantec com <br /> Detrick mcconneliastantee.com deborah lichtenberger@stantec com P w1pn20CS�CLh(�r C Drvl <br /> Empty Kit Relmquwsned by Date Time Method of Shpnrnt <br /> RegQu,sreo oy Ceta "* ompany R ed by DateR • Company <br /> N i 12 141 t, ILDS Srn,',TEC' . Z <br /> R�g,�s�ea cr Deterr.me Company Qecetved by. Oatalrena Congany <br /> R42Q.Isreaoy Daterrime Company Receweaby: Daterrxns Company <br /> Custody Seals Intact Custody Seal NO lCocisur TwMwaoaa(al'CarW01h rRemarks <br /> Yes A No <br />