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2795 2nd Street.Suite 300 <br /> KI FF Davis.CA 95618 <br /> Analytical LLC Lab: 530.297.4800 SRG#/Lab No. Page 2 of 2 <br /> Fax: 530.297.4802 <br /> Send Report To Electronic Data Deliverable(EDD): <br /> Mike Berrington 0 CA EDF 0 CA Writeon ❑ WA ElmChain-of-Custody Record and Analysis Request <br /> Email Address:mberringtonacharter.net TPH 82608 15241 Metals SPECIAL Other <br /> Company:ROM Environmental,Inc. ❑ Excel ❑ EQuIS_ ❑ Other a, <br /> S r <br /> IIO.l y LL <br /> Address:6280 Brookshire Dr-,Rocklin,CA 95677 Global ID(for CA FDF use)70607700243 6 <br /> 5 K c ❑ <br /> o <br /> Phone Number: Fax Number EDD Deliverable To(Email Address): H M - c <br /> (916)749-9222 (916)415-1154 mbenington@charter.net an < 8 LL O <br /> Project#: P.O.#: Sampling Company: Sampler Signature. m m o E o [] E z <br /> RDM Envi Ua w w w o — z <br /> w c LL = a <br /> m 'mv o <br /> Project Name:Huntbrook Holdings-Brockton Invoice To:ROM Environmental,Inc. w zo = m LL <br /> g n d o _ < @ p <a z <br /> m ' 6 o O n w Z ❑ < <br /> Project Address 3138 Samplin #of Containers #Preserved Matrix j F r = ti 0 so w <br /> E Main SL,Stocklon m c o >° " q z z n <br /> w m — m gg ° <br /> N 2 2 <br /> E ZZ <br /> Sample Identification z o o0 o 11 El Date Time m r x z ma o ; ij Di <br /> — <br /> RDM-1-10" 10180013 1300 1 X X X x X X <br /> RDM-1-15' 10180013 1445 1 X X - f X X X X <br /> 17, <br /> MW-8-15-5' 10/8/2013 1400 1 x x x X x x X 7J <br /> MW-8-Z55' 101812013 1410 1 x x x <br /> MW-8-36' 1880013 1829 t x x x 1 <br /> MW-8-46' +0/8/2013 1445 1 x x x x x x 1 <br /> MW-6-15.5' 10/90013 900 t X x 1 X X X x <br /> MW-6-25.5' 10/9/2013 925 1 x X Ix �Q <br /> MW-6-36' 10/90013 940 1 x x x <br /> MW-6-46' 1018/2013 1000 1 x X x x x x <br /> Relinquished by(signature/affiliation) Date 8 Time Received by(sH]naWreJaffiliation) Date 8 Time Remarks aro Special Instructions(composite.filter.MS/MSD,return samples,Silica Gel,etc.) <br /> ..If TPHd reported,run silica get cieanup <br /> R hnquis by(sign ure/aRliaboo). Date 8 Time Received by(signature/affibabon) Date d Time <br /> tU <br /> CD <br /> Relinquished by(slgnaturelafflhation). Date 8 rime Rece,veo Dy Ki If Analytical(signature)'f Date 8 Timet Tunnaround Time(TAT-Check One): <br /> 10 it (%/ p Standard[] a Day[] 3 DaIC 2 Day❑ 1 Day[; timer: <br /> O 1 O O TAT in business days Surcharge may apply. TAT for subcontracted work may vary. <br /> Distnautow. Onginal Lab.Cly Orieimdor <br /> Rev 052113 <br />