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??3/ 7 1 <br /> -1L A Reference#: <br /> TeSTIC"IltmencaTESTAMERICA <br /> San Francisco Chain of Custody <br /> 1220 Quarry Lane • Pleasanton CA 94566-4756 <br /> THE L.EAr)ER IN EtviVIROr IV1115 TAL TrESTING Phone: (925)484-1919 • Fax: (925)600-3002 Date 06-04-19 Page of <br /> Report . Analvsis Request <br /> Attn: �}►.o?— w PSS d l X y o0°o o w <br /> Company: (7H11.o"T'C1 CONSrZ�tC(\6t�1 GA. an d m❑ m o E o U _° ❑ <br /> ❑m a=i °° M o <br /> �, ` �la = ug (5 c5 m <br /> Address: ZH6 (oft6! / y7ryre SnWA UZA ❑ � 0 o— ❑ 'do x❑ z a- <br /> 0,0 <br /> - <br /> ❑ Ca�w vaO ~u <br /> �c O N Q 2N O ^ H <br /> [3rq <br /> ❑ <br /> LW od. E 1111 <br /> Phone: Email:Gly 1IIaI1 0 oM � 0 <br /> in ❑ a- C14 z <br /> Sampled B $ ° U >° 11wBill TO: O E❑ No O -6 Fo0 � 6L °❑ Xa, U f` <br /> U <br /> 20, <br /> ON N 2� F- <br /> 00 mco0w d El ui m O <br /> w w y --0 >(A Attn: Phone. O7 ^ ats w M N U d S a U <br /> NUO U) <br /> DjuJ <br /> ca �V .2 E <br /> Uaa31111 1111 1111 ¢ Z <br /> Sample . Date HmFt ' a > vOaa �❑ <br /> £AMat Pres c <br /> rix <br /> v <br /> cn <br /> CD <br /> w <br /> CD <br /> 0 <br /> CA) <br /> 720-93317 Chain of Custody <br /> _ 2)Relinquished by: 3)Relinquished by: <br /> Project Name: #of Containers: <br /> W Y (SSU .4LhMp S Signature Time Signature Time Signature Time <br /> Project#: Head Space: <br /> 5 8 to I iAiXeZA) PEJUJZ—ss 0(.-611-11 1 <br /> PO#: <br /> (.-ati- <br /> PO#: Sg(' Temp: f `/ L Printed Name Date Printed Name Date Printed Name Date <br /> Credit Card#: Conforms to record: Company Company Company <br /> T 1 5 1)Received by: 2)Received by: 3)Received by: <br /> A 72 48h 24h Other: <br /> T Day ' % <br /> Report: ❑Routine ❑Level 3 ❑Level 4 ❑EDD ❑State Tank Signature Time Signature Time Signature Time <br /> Fund EDF /� n <br /> Special Instructions/Comments: ❑Global ID yv ..R�!t <br /> Printed Name Date Printed Name Date Printed Name Date <br /> rn Cortlpany Company Company <br /> See Terns and Conditions on reverse <br /> N 'TestAmerica SF reports 8015M from C9-C=4(industry norm). Default for 80158 is CWCza <br /> CD Rev02/09 <br />