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TestAmerica Sacramento Chain of Custody Record 213 9 9 0 TestAmenca <br /> 880 Rfieetside i'aettttay <br /> THE LEADERIN ENyIRONMENTAL TESTING <br /> U"t tacranente, Cdr 95605 TestAmerica Laboratories,Inc. <br /> Pfime: 916.373.5600 Fax: Regulatory Program: ❑Dw ❑NPOES ❑RCRA ❑other: TAL-8210(0713) <br /> Client Contact Project Manager: Site Contact: Maw `a , Date: (p t(j COC No <br /> Company Name. r,;ryr, "7 ;' TellFax: Lab Contact:a. Carrier: of C <br /> Address. =3 rn s+c._kA Analysis Turnaround Time Sampler. <br /> City/State/Zip r ❑ CALENDAR DAYS ❑ WORKING DAYS For Lab Use Only: <br /> Phone 5 — TAT if drfferent from Below Walk-in Client: <br /> Fax: ❑ 2 weeks Lab Sampling: <br /> z r <br /> Project Name. I week y <br /> Site: ❑ 2 days m U) d Job I SDG No.: <br /> PO# ❑ Iday E y <br /> Sample vi <br /> rs <br /> Sample Sample i com, #of m it 4* <br /> Sample Identification Date Time G=Grab) Matrix cont. Sample Specific Notes. <br /> S PO 1 c)�11�! X <br /> S�c�1�, 2- to t cS�rq i,Jl a- X <br /> 440 24351(3 Chain of-I-ILI-1 1111 <br /> Custad <br /> kill <br /> Preservation Used: 1=lce, 2=HCI; 3=H2SO4; 4=HNO3; 51-:NaOH,8@ Other � . .. . . :_J L.J_ <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 /> ❑Nor-Hazard ❑Flammable ❑Skin Irritant ❑Poison B ❑unknown ❑Return to client ❑Disposal by Lab ❑Archive for Months <br /> Special Instructions=Requirements a Comments: <br /> ZZ <br /> Custody Seals Intact- ❑ Yes ❑ No Custody Seal No lCooler Temp ( C). bs orr'd: Fherm ID No.7211= <br /> linquished by Company Date/Mme: Received by Company. Date/Time <br /> ZK&Wios irtv 61'011 E--0 5 V:_ (0110 It A � 7_- <br /> Relinqui hed by Company DatelTime: Received by Company: Date/Time <br /> Relinquished by. 55 � Company Date/Time. Received in L ora Com Dat T, �5 <br /> A ivL/(l� Y q <br /> U <br /> e nn n n <br />