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❑ F-1 LILI Ll e <br /> .�. gar, c 4.,.a j t;rdmianto � <br /> 0 0 Riverside par=lacy Chain of Custody Record j� ��y`Z A °� N <br /> .,�., 7 ' '•1x'1,tk'alh':S'"�'.i':`��@iX�Mv"4�;;i:htg4:�.+�2�.�' 0o <br /> Ues � IC3`d0l�°il�ttr � � -r: r oi'R rhvl ur.M r: 4: rF.Fr;c r <br /> Phone: 9$6-3T3_5Es-M Fax: TestAmerica Laboratories,Inc. � <br /> Regulatory Program; �� L]NPDEs [I RCRA Other, TAL-821010783) <br /> Client Contact Project Manager: Site Contact-Me,...y Iia.' Bate: y C7 COG No <br /> Company Name n"Q Tel/Fax: —r] Lab Contact: Carrier: <br /> Address r i ri <br /> Analysis Turnaround Time # Sampler <br /> CityiS[ate/Zip CALENDAR DAYS r'WORKING DAYS For Lab Use Only: <br /> Phooe TAr if different from BelowS Walk-In Client <br /> Fax _1 2 weeks � Z � t5 � I a q � Lab Sampling <br /> Prolecr Name — week o — 7 <br /> 0 ¢ <br /> Site �5�1' 2 days d A Sob!SDG No <br /> P�# Iday <br /> Sample rn �{ <br /> 3' - � <br /> Sample Sample tc Type P, #of Z � � �,jf <br /> Sample identification hate Time c=o ah) Matrix Cont ii Sample Specific Notes <br /> YhOIR 1 Jq6 G LO <br /> r'e"it.J cttit�. <br /> eel � 4 <br /> P N <br /> O <br /> 720-788N5Gharof <br /> Custody <br /> Preservation Used: 1-Ice, 2=HCI; '3g H2504; PRRA 73; FOR 6-oftt <br /> Possible Hazard Identification: Sample Disposal(A Efee may be assessed it samples are retained longer than 9 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 It the lab is to dispose of the sample <br /> Nnn-Hazard Flammable iSkin irritant __I Poison B r Unknovin -1 Return to Client CJisposal by Lab Archive ior___,_ _ Months <br /> Special InstructionsKdC Requirements&Comments: <br /> ustody eats Intact res rlo Custody Seal No ooler emp ('C) bs'd _ _ orr'd: _ herm I No <br /> Reli quis by Compal( DateMme Received b Company_ <br /> � f��tJ• I`j7Js'>U� tp 1?� � ;;,f ✓fir/�, <br /> Relinquished by Company. Date/Time Re 'NeiTby Company Dite/Trme ? <br /> )Relinquished by Company bate/Time Received m Laboratory by Company tate/Time <br />