Laserfiche WebLink
TestAmerica Sacramento Chain of Custody Record TestmeriCa <br /> 880 Riverside Parkway - � �� � /� <br /> THE LOADER IN ENVIRONMENTAL TESTING <br /> West Sacramento,CA 95605-1500 <br /> phone 916.373 5600 fax 303.467 7248 Regulatory Program: o DW ❑NPDES ❑RCRA D other: TestAmerica Laboratories,Inc. <br /> Client Contact Project Manager:Wyatt Murray Site Contact:Brian McCarty Date: 1;_. <br /> •I T COC No: 001 <br /> GHD TellFax:317-291-7010 Lab Contact: Carrier:Patriot Environmental _1_ of_1_ COCs <br /> 6520 Corporate Dr Analysis Turnaround Time Sampler <br /> Indianapolis,IN 46278 2 CALENDAR DAYS ❑ WORKING DAYS For Lab Use Only: <br /> Email Results to Wyatt.MurraGHD.com TAT If drflerent from Below _Z Walk-in Client. <br /> (xxx)xxX-xxxx FAX o 2 weeks Z >_ C Lab Sampling: <br /> Project Name UPRR Tracy O 1 week } o <br /> Site Tracy Sub-station G 2 days a g Job I SDG No.: <br /> P O#WR#19721 0 1 day E H ' <br /> pe . f J <br /> Sample Samplet Type a or m ' , <br /> Sample Identification Q Date Time G=Grab) Matrix cont. ii a Sample Specific Notes: <br /> WR#19721 / 15 t4 ( C vI I Ix X X <br /> 7 <br /> tQ <br /> (D <br /> O <br /> O <br /> W <br /> O <br /> 720-91968 Chain of Custody <br /> Preservation Used: 1m Ice, 2=HCI; 3=H2SO4; 4=HNO3; 6=NaOH;5=Other <br /> Possible Hazard Identification: Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Are any samples from a listed EPA Hazardous Waste? Please List any EPA Waste Codes for the sample in the <br /> Comments Section if the lab is to dispose of the sample. <br /> ❑Non-Hazard O Sion Irritant ❑Poison B ❑Unknown ❑Return to Client Q Ois2Qal by Lah O Archive for Months <br /> Special Instructions/QC Requirements&Comments: Please send analytical findings to Wyatt.Murray@GHD.com <br /> Custody Seais Intact ❑ Yes n No Custody Seal No. Cooler Temp.(C).Obs'd Corr d: Therm ID No.. <br /> Relinquished by Comp DaterTimeI toT ?•ft•fl : n <br /> r( <br /> Relinquished by ai C + ny.� DDt l irpe: 6. .eceived d �«�' Company. T��2b DateMme � � I� ncc� <br /> i <br /> W Relinquished by Company: Date/time Received in Laboratory by Company- Datemme <br /> v <br /> IV <br /> O Form No.CA-C-WI-002,Rev.4.20,dated 212812019 <br /> N <br /> 13 <br /> O_ <br /> O <br />