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TestAmeri—"'vine <br /> 17461 DerianA% ite 100 Chair, i Custody Record TestAn xica <br /> Irvine, CA 92614-5817 <br /> '>tC IC�pCo'v Cvvv��vr:�-.--CST•\ <br /> Phone(949)261-1022 Fax(949)260-3297 <br /> Sampler. Let PM' Carrier Tracking No(s)' COC No <br /> Client Infontlafion victoria Blanchard Davidkova,Lena <br /> Client contact Phone: E-Map: Page, <br /> Brian Westhoff(StantecyAlexis Fischer(CEMC PM) 1916-384-07101916-494-2824 Jena.davidkova@testamedcafnc.com Page 1 of 1 <br /> Co^+pa ny Job 4, <br /> Stantec Consulting Corp./CEMC:Alexis Fischer 925-790-6441,6101 Bollinger Canyon Rd.,San Ramon,CA Analysis Requested <br /> Address, Due Date Requested: Preservation Codes: <br /> 3017 Kilgore Road Suite 100 A-HCL M-Hexane <br /> City. TAT Requested(days): 8-NaOH N-None <br /> Rancho Cordova 48 Hours C-zr Acetate 0-AsNa02 <br /> Slate,ZJP. D-Nitric Md P-Na204S <br /> _ E-NaHSO4 0-N22S03 <br /> CA,95670 F-VeOH R-Na2S2SO3 <br /> Phone. Global ID G-AmUlor S-H2SO4 <br /> 916-384-0710(Tel) H-Ascorbic Acid T-TSP Dodewhydrate <br /> Email 09 ::." I-Ice U-Acetone <br /> nan.W h ffstan m J-Dl Water V-MCAA <br /> K-EDTA W-ph d4-5L•EDA z-oN <br /> Prolect Name: P•gect K: <br /> CVX 9-6171 213202493 ^e other(spec y) <br /> a=. <br /> Site: SSOWs• Other. <br /> 6633 Pacific Avenue,Stockton CA 95207 t2 n <br /> g o <br /> M atrix <br /> Sample <br /> Type (rr•w�r.. r a �. z O ;. 7 <br /> Sample (C=comp, <br /> k' Special <br /> a � o <br /> See below <br /> NOD BA-1 S X X X X X X X <br /> See below <br /> N BA-1 S X X X X X X X <br /> BA-2 <br /> S X X X X <br /> BA-2 S X X X X <br /> BA-3 S X X X X <br /> BA-3 S X X X X <br /> i I •,i`. <br /> 440-84744 Chain of Custody <br /> Possible Hazard klendflcation Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> (=Non-Hazard =Flammable =Skin imtant Poison B Unknown Radio ical =Return To Client =Disposal By Lab = Archive For Months <br /> Deliverable Requested:1,II,111,IV,Other(specify) Special lnstructionslOC Requirements: If impacts are above 10 mg/kg then Title 22 Metals and PCBs will <br /> Empty Krt Relinquished by Date: Time: Method or Shipment S <br /> 0o Ralinqueshetl b Date?me. COmpary R rve Y. Daterri Comppgµ_ <br /> N Rellnqumhed by r Datenima: Company Recelved by. Date/i...e Company <br /> O <br /> A Relinquished by. oaterrx m Company Received by. Da e l r e: Company <br /> Custody Seals Intact Custody Seal No.: Coder Temperature(s)°C and Omer Rema �L t <br /> A Yes e NO L <br />