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• • • • • • • • • • • <br /> K/FF th Davi 92nd Street,Suite 300 ^_ <br /> Davis,CA 95618 \(fl\/ <br /> Analytical LLC Lab: 530.2974800 SRG#i Lab No. Paue 1 of <br /> Fax: 530.297.4802 - <br /> Send Report To: Electronic Data Deliverable(EDD) <br /> Mike Berrington Chain-of-Custody Record and Analysis Request <br /> 0' CA EDF El CA Vinteon ❑ WA EIM <br /> Email Address: mberrington@chader.nel T 82608 15241 Metals I SPECIAL Other <br /> Company:ROM Environmental, Inc. ❑ Excel F1 EQuIS ❑ Other_- w <br /> t- <br /> O d _ <br /> Address 6280 Brookshire Dr..Rocklin,CA 95677 Global ID(for CA EDF use):T0607700243 0 <br /> Z X n <br /> Phone Number. Fax Number: EDD Deliverable To(Email Address): ❑ o F >, <br /> (916)749-9222 (916)415-1154 mberringlon@chaner.net <br /> 0 <br /> Project#: P.O. _n ComPay o L'" zSampler Signature: <br /> ROM Environmental .2 E <br /> m <br /> o E <br /> 0 r N U �y g 0 d z m m <br /> Project Name:Huntbrook Holdings-Stockton Invoice To ROM Environmental,Inc o t m a _ v o <br /> ° n <br /> m o <br /> Project Address Sampin #ofCotainers Peserved b o o z n <br /> Matrix > r ti - 0 m o w <br /> 3138 E Main St-Stockton `. L '�, u <br /> Ej <br /> zNiy0 z <br /> C2ms <br /> I G Nqd <br /> jflj> ° 2 <br /> Sample Identification o Eavz mo13 <br /> — 2 z Date Time <br /> o <br /> Li 11c` O <br /> SP-la,b.c,d 1a/m2013 1000 x x x x X <br /> T-r------1-1r) fl ITT I I I <br /> I I# I I I I <br /> Relinquished by(signatur ffiliati n)' Dale 8 Time Received by(signalureraRliation). Date&Time Remarks and Special Instructions(composite.(Ater.MS/MSD.return samples.Silica Cal,Pic) <br /> /l'rt,w cer..�o{i1(e i.n�o our. <br /> elinquish b (signature/ Aianon). Date&Time Received by(signaturetaffliation), Date&Time <br /> Ill <br /> N Relinquished by(signaturataffiliation) Date&Time Rec_aveeg by K/M Analytical(signature). Date&Time Turnaround Time(TAT-Check One): <br /> co " �{/ lyll I CG standard p 4 Day 0 3 DayCJ 2 Day p 1 Day Other. <br /> DieiTAT in business days_ Surcharge may apply IAT fa subcontracted work may vary <br /> Rey OS05 on Origina�-Lab,Cooy-OABinalor <br /> � Rev. tt3 <br />