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TestAmerica West Sacramento <br /> 880 Riverside Parkway Chain of Custody Record T=St 'me,,icc <br /> r. <br /> West Sacramento.CA 95605 a` <br /> Phone 916 373-5600 <br /> Sampler Lao PM Cerner Tracking Nofs1 CCC No <br /> Client Information Brian Branscum Wagner,Heather <br /> C'ient Cortin. Phone E Mad Page <br /> Amanda Magee 916 281.8361 heather wa nen testamericainc.com Pae of <br /> Company icr• <br /> Stantec Consulting Services Inc Analysis Re uested <br /> Address Due Date Requested: Preservation Coder <br /> 3875 Atherton Road A-HCL M-Hexane <br /> C,yy TAT Requested(dayst: s+ <br /> 9-NaDH N-None <br /> Rocklin 24 H R a C-Zn Acetate O-ASNaC2 <br /> slate.Z W D-N'tr.0 AOd P-Na204S <br /> CA.95765 WE NeHSO4 0-Ne2S03 <br /> P.McOH R-No2S2S03 <br /> Phone PO• G-Amchlor S-H2SO4 <br /> (916)472-3985 Z H•AScorb+C Acid T-TSP Dodecanycirate <br /> Ems.] `N0 w <br /> -Ice u-Acetone <br /> fe -S`a''' W0230335 ° $ m ES ,1-DI Water V•MCAA <br /> proleat Name Proles e p < K-EDTA W-ph 4.5 <br /> Stantec-CA-non-ENFOS >C g W i L-EDA Z-wria,cecfiyl <br /> SIU SSOWM a W <br /> Other: <br /> 7-Eleven#19976 0 m o to b <br /> m g <br /> 7G � W <br /> Sample Matrix a g g F m E <br /> Type (w•«.w., LL W w 4 y z <br /> 9—ft. 75 <br /> Sample (C-comp, 0— <br /> Sample <br /> ...Sam le Identification Sample Date Time G-grab) eT•TN•w.MAY M 0 > z r• Special Instructions/Note: <br /> Preservation Code <br /> CDD 12/14/16 U7 LD G S X X X X X X X 1 <br /> Co <br /> to <br /> I <br /> Z 320-24364 Chain of Custody <br /> Possible Hazard Identification Sam le Disposal(A fee maybe assessed if samples are retained longer than t month) <br /> =Non-Hazard =Flammable Skin Imtant ID Poison B Unknown Radiological �Retum To Client O D/s osal By Lab U Archive For Months <br /> Deliverable Requested 1 II Ill,IV.Other(specify) II Special Instructions/QC Requirements. Email lab report to amande magee®stantec com. <br /> patnck mcconnellgstantec corn,deborah lichtenberger(§stantec corn;CmDn2oeSjctll l co,-n <br /> Empty Kit Relinquished by Date Time Melrpo of Snpment <br /> RelSqu.vreo by Cera me ompany Ret vea by Deert s Company <br /> N 7 )2 ►`� tt, 1205 sriWTE rix 7 Z f <br /> Rtai�q.usned by CatmTme Ccmpany Received by Dater-ime company <br /> R®gcished by Datelnme Cempany Received by Dolor'" Company <br /> Custody Seals Intact CWtOdy Seal No Cooler Tempe,al�,•e!sl`C ana Otner Remarks <br /> yes .1 No <br />