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TestAmerica Irvine <br />17461 Derian Ave Suite 100 <br />Irvine, CA 92614-5817 <br />Phnn. IQdgl 261-tn77 Fav IQAQI 26n_17Q7 <br />Chain of Custody Record <br />TesfAmedca <br />TME LEADER IN EN'✓IRO..ENTAL IESTrNG <br />V <br />O <br />N <br />(D <br />N <br />r <br />J <br />JzZ <br />Zw <br />W <br />5� <br />LQ <br />Z 0 <br />Cr— J <br />56 <br />ZZ <br />W <br />Sampler: <br />Lab PM: <br />Cartier Trackog No(S) : <br />COC No: <br />Client Information Sub Contract Lab <br />Clark, Heather <br />440-2180.1 <br />Client Contact <br />ph.—. <br />E -Mail. <br />Page. <br />Shipping/Receiving <br />heather.clark@testamericainc com <br />Page 1 of 1 <br />Company <br />Job M: - <br />Aquatic Testing Laboratories Analysis Re uested <br />440-2207-2 <br />Address Due Date Requested: <br />Preservation Codes: <br />4350 Transport#107, 3/15/2012 <br />A - HCL M -Hexane <br />B - NaOH N Nona <br />Z; y TAT Requested (days): <br />Ventura <br />C - Zn Acetate O -A 11:02 <br />State, Zip. <br />D - Nitric Aud P - Na2O4S <br />ChA, a 3003 <br />Y <br />E-NaHSO4 0-Na2S03 <br />F - McOH R - Na2S2SO3 <br />G - Amchlor S - Ft2SO4 � <br />Phone <br />�# <br />E <br />s <br />�' <br />H • Ascorbic Aatl T - TSP Dotlecr�dr� <br />1-108 U -Acetone <br />Email: WO #: <br />= <br />J • DI Water v - MCAA rtr <br />4 <br />K - EDTA W - ph -5 <br />Project Name: Project k: <br />UPRR-Stockton 44004342 <br />+ <br />= <br />o <br />L - EDA Z-0 <br />Other. <br />Site: SSOWX <br />r <br />U <br />Sample <br />Matrix <br />Type <br />(v....r.o <br />Sample <br />(C=comp. <br />hwN, <br />o- .. K <br />m <br />Sample Identification - Client ID Lab ID Sam le Date Time <br />arc <br />G= grab) <br />aT-Ti,—.A-w <br />ee <br />Special Instructions/Note: <br />SS -1 (440-2207-1) 2/8/12 13:30 <br />Solid <br />X <br />Possible Hazard Identification <br />Sa�m Disposal (A fee may be assessed if samples are retained longer than 1 month) <br />jle <br />= <br />" <br />Unconfirmed <br />Return To Client Disposal By Lab Archive For Months <br />Deliverable Requested: I, II, III, IV, Other (specify) <br />Special InstructionslOC Requirements: <br />Empty Relin by: If Date: Time: Method of Shipment <br />Relin <br />�mP <br />/f' - <br />Company <br />Received by <br />Dat 1 <br />5 <br />Comper/Y7. <br />R i ished by. <br />Da <br />C <br />Received by: <br />Dat�me <br />Company <br />3 3d <br />I <br />s <br />Relinquished by <br />Daterriime <br />Company <br />Received by: <br />DatarTime <br />Compam <br />Custody Seals Intal: <br />Custody Seal No.: <br />Ternperature(s)'c and Other Remarks: <br />A Yes A IN <br />�+ <br />V <br />O <br />N <br />(D <br />N <br />r <br />J <br />JzZ <br />Zw <br />W <br />5� <br />LQ <br />Z 0 <br />Cr— J <br />56 <br />ZZ <br />W <br />