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TestAmeflr'-urine Testes �,nCG <br /> 17461 Derian A. to 100 Chair. J Custody Record <br /> Irvine, CA 92614-5817 <br /> 'M[ICADC4'v CVvivpYM(�'+-"CST�G <br /> Phone(949)261-1022 Fax(949)260-3297 <br /> Sampler Lab PM- Carrier Tracking No(s). COC No. <br /> Client Information Victoria Blanchard Davidkova,Lena <br /> Clier:Contact Phooe: E-MaO: Page. <br /> Brian Westhoff(Stantec)/Alexis Fischer(CEMC PM) 9i6-38407101916-494-2824 Jena.davidkova@testamencainc.com Page 1 of 1 <br /> Cc^,parry Job rr: <br /> Stantec Consulting Corp./CEMC:Alexis Fischer 925-790-6441,6101 Bollinger Canyon Rd.,San Ramon,CA Analysis Requested <br /> ross. Due Date Requested: :Preservation Codes: <br /> 3017 Kilgore Road Suite 100A-HCL M-Hexare <br /> Ci!y. TAT Requested(days): B-NaOH N-None <br /> Rancho Cordova 48 Hours .j C-zn Acetate 0-AsNaO2 <br /> State, O-Nitric Add P-Na2O4S <br /> zip" <br /> CA.95, E-NaHSO4 0-Na2S03 <br /> 'C', F-M00H R-Na2SZS03 <br /> Phone. Gtobal ID •. G-Amchior S-H2SOa <br /> 916-364-0710(fel) t:.4 H-Ascortxc Aad T-TSP Dodecahydrate <br /> Email, wo�. +' I-k:e U-Acetone <br /> Brian WeSthoffjastantec.com J-Dl Water V.MCAA <br /> A <br /> Project Name. P"ct# L-EDAZ-other(speedy) <br /> CVX 9-6171 213202493 <br /> Site: s50wrt: DOM <br /> 6633 Pacific Avenue,Stockton CA 95207 " <br /> $ 10 <br /> m <br /> Sample Matrix <br /> 4 W N <br /> Type ( a cc a a <br /> Sample (C-comp, o-....rr.a, <br /> w Saimple Identification Sample Date Time G=grab) a m.u.Aw o m w > special Instructions/Note: <br /> cn BA-1-W G w x x x x x x <br /> O r <br /> NBA-2-W G W x x x x <br /> O <br /> BA-3-W G W x x x x <br /> Trip Blank <br /> 440-84727 Chain of Custody I <br /> Possible Hazard/dentiticartfon Sample Disposal(A fee maybe assessed if samples are retalned longer than 1 month) <br /> Non-Hazard C Flammable Skin Irritant Poison B Unknown Radiological Return To Client Disposal By Lab Archive For Months <br /> Deliverable Requested:I,It,III,N,Other(specify) Special InstructionsIOC Requtremerts: <br /> Empty Kit Relinquished by Date: Time: Method of shipment ` <br /> co Rei nquW e b Datarttne, +L Cornpany Received by. Dat cmva _ <br /> N Relmquishe y Date/Tme. Company Received by Compary <br /> O <br /> A Relinquished by. tate;Tme: Company Received by Daterl-me: Compary <br /> Custody Seals Intact: Custody Seal No.. Cower Temperature(s)'C and Other Remarks-^L <br /> A Yes A No <br />