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TestAmerica Irvine Te'stmen .a <br /> 17461 Derian Ave Suite 100 Chain of Custody Record <br /> Irvine, CA 926144817 <br /> T1fE 1fiADlKr 9N ENV1rtQNM(;,NTAL TE= <br /> Phone(949)261-1022 Fax(949)260-3297 <br /> Sampler Lab PM Carrier Tracking Na($), COC No; <br /> Client Information Matt McDermott Roberts,Danielle C <br /> Giant Contact Phone. E-Mad Page: <br /> Brandon Thomas I Naomi Fox 800-619-97331847-740-9177 danielte rat tts@testamericainc.com Pagel of 1 <br /> Company, .fob# <br /> GMG EnviroSafe Analysis Requested <br /> Address: IPO <br /> e Data Requested: Preservation Codes: <br /> 1658 N.Milwaukee Ave-Suite 287 912026 M A-MCL M-Hexane <br /> ss, <br /> CdY. T Requested(days): ,., Y B-NaOH N-None <br /> Chicago kl" C-Zn Acetate O-AsNaO2 <br /> State,Zip <br /> '�' b• D-Nitric Acid P-Na2O4S <br /> IL E-NafiSO4 O-Na2503 <br /> Phone #• 7 F-McOH R-Na2S2SO3 <br /> 847-740-9177 c "'p"' H-Ascom Acid T-SP Dodmahydrate <br /> Email* WO# +A' '' 1-108 U-Acetone <br /> nfox amaenyirosafe com y J-DI Water V-MCAA <br /> Project Name Project# K-EDTA W-ph 4-5 <br /> L-EDA Z-other(specify) <br /> Certified Collision Center-Stockton ; <br /> Site SSOW# ether: (� <br /> 7710 Murray Drive,Stockton,CA 95210 , <br /> E <br /> Sample Matrix ma <br /> I _ , gSampe <br /> Sam e DatTimesrur ,�wu.Sam le identification vg <br /> w:- d RSpecial InstructionsfNate: <br /> ciallnstructionslNote: <br /> , <br /> .r - i..:p., .,�', ,ai. sz - ,,.CDde',` `w"• ','��' la„ ;',"'• �', - i-, �1+�, - ':alis ,�, ra, 'Cd,) <br /> (D faint Booth Filter (TCLP testing only)24 hr turnaround 117120 8AM G S x ;r1 <br /> O 'z <br /> Ph' <br /> L11!111 <br /> hain Df Custod <br /> n^x <br /> Possible Hazard Identification r—� Sam�jle Disposal(A fee may be assessed if samples are retained longer than t month) <br /> ©Non-Hazard ©Flammable ©Skin irritant =1 Poison B known '�;diola ical '""""Return To Client ©Disposal By Lab ©Amhrve For Months <br /> Deliverable Requested:I,II,III,IV,Other(specify) Special InstructionsloC Requirements: <br /> Empty Kit Relinquished by:Naomi Fox Date:1/812020 Time:4:0OPM Method of Shipment.UPS Nxt Day Air <br /> Relinquished by.Matt McDermott Date(Tane AM2020 f" Company Received by Naomi Fox Daterfime:11812020 11 Mm Company <br /> Certified GMG EriviroSafe <br /> Reknquished by Naomi Fox Date/Time,VW020 4PM Company Received by. Datelfime Company <br /> GMG EnviroSafe <br /> Rehrtqu sheds a Company Rete ay DqaT Company <br /> N <br /> Custody SealsVlntact: Custod refs)°C and Other Remarks <br /> O y Seal No.: Cooler T <br /> CD d yes A No j' <br />