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West Sacramento <br />880 Riverside Parkway <br />West Sacramento, CA 95605 <br />phone 916.374.4378 fax 916.372.1059 <br />Chain of Custody Record <br />-17ve713i <br />TestAmerica Laboratories, Inc. <br />Client Contact Protect Manager: Site Contact: Date: 'z / COC No: <br />Apex Companies, LLC TeUFaX S — ff --1/ 2 Lab Contact: Carrier. of CDCs <br />8185 Cornerstone Court, #110 Analysis Turnaround Time <br />— <br />u <br />�— <br />a.. <br />�+ <br />1 <br />Job No. <br />San Diego, CA 82121 Calendar ( C ) or Work Days (W) V <br />(858) 558-1120 Phone TAT ifdiffe.t fmm Betow 7 4144. <br />(858) 558-1121 FAX 2 weeks <br />Project Name: hi I week <br />Site: 2 days `i <br />Po# day 4' <br />SDG No. <br />r� <br />Sample Sample Sampl a of - <br />Sam le Identification Date Time Type atrix Cont <br />Sample Specific Notes: <br />13rpt etav -`. 5'z 4 2w .tn <br />Preservation Used: I- Ice, 2— HCl; 3= H2SO4; 4=HNO3; S=NaOH; 6= Other <br />Possible Hazard Identification Sample Disposal (A fee may be assessed [f samples are retained longer than 1 month) <br />Non -Hazard Flammable Skin Irritant Poison B Unknown Return To Client Disposal By Lab Archive For Months <br />Special Instructions/QC Requirements & Comments: <br />Relinquished by: Co pony: D 'me: Received by: Company: Date/I'ime: <br />O ww e 2 is �(� e Ts w, S� t" ;.y I -&-r r t 1 T r S <br />Relinquished by: <br />Co pany: <br />r•� wdA. (-�01-Ytloq <br />Date/Time: R by Company: r <br />/i ir( �(r <br />Date/Time: <br />6`ZS✓l/ 0r2® <br />Retin y' <br />Company: r <br />eST ,,C}y Oe -4 rk <br />DaMT4L-11 R eived n : Compa <br />1 ?ju-o o � <br />Dates <br />O> O -CQ w <br />Form No. CA' C_WI 02dated�04/0 7p��1 <br />I <br />I <br />