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CHAIN OF CUSTODY CLS ID. NO. <br /> Report To: Client Job Number ANALYSIS REQUESTED <br /> GEOTRACKER <br /> ACTenviro Destination Laboratory <br /> EDF REPORT ❑ YES ❑ NO <br /> 4 Wayne Ct Sacramento CA 95&29#9 j <br /> 1 <br /> CALIFORNIA LABORATORY SERVICES ! GLOBAL ID. <br /> Project Manager <br /> Jeff Freitas jfreitas@acterviro.com m <br /> Project Name Tower Park Marina Resort ❑ CLS (916) 638-7301 M FIELD CONDITIONS: <br /> Sampled By i 3249 Fitzgerald Road <br /> Jeff Freitas Rancho Cordova,CA C <br /> 95742 m <br /> Job Description wti��.californialab.com <br /> Treated Wood Waste(TWW) <br /> I O n rn <br /> ❑ OTHER O -V N <br /> U <br /> Site Location 14900 W Higtway 12 Lodi CA 95242 Z ! TURNAROUND <br /> n n TIME IN DAYS SPECIAL INSTRUCTIONS <br /> DATE TIME SAMPLE FIELD CONTAINER T 2 3 ` S , <br /> / IDENTIFICATION ID. MATRIX NO. TYPE <br /> i I I <br /> I <br /> I <br /> I <br /> INVOICE TO: <br /> jfreitasuactenviro.com <br /> PO#5021-0185 <br /> QUOTE# <br /> SUSPECTED CONSTITUENTS SAMPLE RETENTION TIME I PRESERVATIVES (1) HCL (3)=COLD <br /> 2 HNO3 i4)=H2SO4 <br /> RE NQUISHED BY (Signature) PRINT NAME/COMPANY DATE/TIME ROEIVEQ BY Signat re) PRINT NAME/COMPANY <br /> Jeff Freitas/ACTenviro <br /> REOM AT LAB BY: DATE/TIME—7 7D2 CONDI Ns/COMMENTS: S7,3 <br /> J SHIPPED BY: ❑ FED EX 0 UPS ❑ OTHER AIR BILL# <br />