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1-11 1111 E <br /> lestRmerica Sacramento <br /> agov°re Par;Fay Chain o ustody Re ord <br /> 9 <br /> !$ aCl'+9i1�fl fl, 9SG05 <br /> 1675 a��e u�s�a�ety� ���,,yw.,,.s„K„•s: e��l <br /> 7HE LFADER ill ENVtRUNWWAl It`ti?A; <br /> Phone: 916373.S61-1-4 Fir. TestAmerica Laboratories,Inc. r <br /> Regulatory Program: ❑Dw (_I Naoes []RCRA r',aches. TaL-azto land <br /> Client Contact Project Manager: Site Contact;u merprl i Elate: COC No, <br /> Company Name TellFax: 0 Lab Contact: d @r- ,1Carrier: _ of_ CDCs <br /> Address5 �-. Analysis Turnaround Time I Sampler <br /> CityfStatelZ€p y CALENDAR DAYS WORKING DAYS For Lab Use Only: <br /> Phone TAT(fad€arentfrom 94ak- _ _ Z tl Walk-in Client <br /> Fax k 1� 2 weeks �3 Lab Samptsng <br /> Project Name VMcI. 1 week <br /> sae I j P R R— 5ioC_ 2 daysJ! fl, 3j �s i sof Job!St7G No <br /> } A <br /> P11# l D 1 day 1 rn T -v d r <br /> Sample rn t <br /> Sample Sample { PeC v. #ot m t Q, 0 qt }— <br /> Sample Identification Date Time c=Gran) Matrix cont, iz a t— Sample Specific Notes <br /> Y/p/1 I I G- U) 31 X x X X K x x YC x X X 74 X l/ 9 <br /> a7 re d>J''d v - itt m - <br /> on <br /> t9 <br /> (v <br /> CO <br /> 72Q-78844 Gha€n of Custody <br /> Preservation Used: 1a ice, 2--HCI,, 3-H2304, 4s;HN04; 5,MNaAH;6-Other <br /> Possible Hazard Identification: Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Are any samples from a listed EPA Hazardous Waste? Please List any EPA Waste Codes for the sample in the <br /> Comments Section if the lab is to dispose of the sample <br /> Non-Hazard _I Flammable j Sk€n Irritant J Po€son 8 �__1 Unknown 2i Return to Cent k�1},sposal by Lai i Archive For _ _ M11on€hs <br /> Special instructionslQC Requirements&Comments: f / <br /> - d w,br o k � . rte,,, c� c"T-7 w<�S�Cs �t1 f •U&) ' t�❑ S�� ro <br /> C tody Seals ntact ves _ No Custody Seat No. CoolerTemp,(C).Obsd _ orr'd Ther 0NS/4 <br /> C �l,,OL � Nof <br /> DqteMme Receive — Company: DateLTf � y <br /> Relinquished by Company Da[[IltelTime cetved by Company DatelTime <br /> Relinquished by Company DateMme. Received in Laboratory by Company Date/Time <br />