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TestAmerica Sacramento Chain of Custody Record TestAmehca <br /> 880 Riverside Parkway slillis <br /> .i AULN i.N C WN041.ILNIAL IfsUp" <br /> West Sacramento,CA 95605-15D0 _ _ <br /> phone 916.373.5500 fax 303.467 7248 Regulatory ProgramDD'w NPDES . .Rum —mer TestAmeNea Laboratories,Inc. <br /> Client Contact Project Manager:Kim Brandt Site Contact:Jeremie Ruest Date:1128/2019 CCC No. <br /> Geosyntec Consultants TelfFax:(925)235-9306 Lab Contact:Laura Turpen Carrier: _1_ of_1_ COCs <br /> 1111 Broadway,8th Floor Analysis Turnaround Time 9 Sampler. <br /> Oakland,CA 94697 cRs EnDrdt DAYS wORxi DAYS W For Lab Use Only: <br /> 510 836-3034 Phone TAT ddMerenf from P.elow z n s _ = Walk-in Client: <br /> FAX z wWks Z y m w � ?e r = Lab Sampling: <br /> Project Name.Pod of Stockton t week } o W m o w Q e <br /> Site:UST investigation 2 days a in a w i o c c Job 1 SDG No.: <br /> P O#WR2501 1 day Ern –'a <br /> Sample w m : x r x y 2e <br /> Type 2 o 5 o o m e m LL <br /> Sample Sample tc=c P, Mat t n a p e B s 9 a = z m 0 <br /> Sample Identification Date Time o-Grab) Matrix cant ii a i i m m m x m m i != i Sample Specific Notea <br /> PS-UST-SS-517-GIA-4 1128119 1430 G S 5 X X <br /> PS-UST-SS-605-91A-4 1128119 1330 G S 4 X X <br /> PS-UST-SS-817E-01A-4 1128119 0645 G S 5 X X <br /> PS-UST-SS-817B-02A-0 1128!19 1000 G 5 5 X X <br /> PS-UST-SS-817B-03A-4 1/28119 0930 G S 7 Y X <br /> v <br /> PS-USTSS-817B-04AA 1/28119 0905 G S 4 X <br /> CCr D 320-47216 Chain of Custody <br /> PS-USTSS-8178-05A4 1128119 0945 G 5 4 X <br /> PS-UST-SS-916B-o1A4 1128119 1120 G S 5 X X <br /> CY <br /> PS-UST-SS-9168-02A-W 1128119 1145 G W 6 Y X <br /> DUP 1128119 0000 G W 2 X <br /> EB-012819 1128119 1420 G W 4 X X <br /> TB-012819 1128119 0000 G W 3 X <br /> 1DW-S-012819 1128119 1500 G S 5 X X X <br /> IDW-W-012819 1128119 1445 G W 3 X <br /> Preservation Used: 1=Ice, 2=HCI; 3=H2SO4; 4=HNO3; 5=NaOH;6=Other <br /> Possible Hazard Identification: Sample Disposal(A tee 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 Plammabi Return to dint - 1by fab Ar�liv¢far Months <br /> Special Instructions/QC Requirements 8 Comments, <br /> `�-,1 z• l <br /> Custody Seals Intact: : ye, ❑No Custody Seal No.: Cooler Temp.(°C):Obs'd V Cored: ' Therm ID No.: <br /> Relinquished by ; Company DatefTime: Received by: Company: Date ime: <br /> Relinquished by: Company: DateMme: Re ce o any. DatefTime: <br /> 4P 4 <br /> Relinquished by Company: al fume: Received fn or tory by: Company: Datefrime: <br /> N <br /> O o A4�m O n k,Q1 ` S�Z{ aP' , y 4 ',I <br /> Form No.CA-C-WI-002,Rev.4.15,dated 912712017' <br /> Q0 1` C� <br />