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TestAmerica Sacramento Canister Samples Chain of Custody Record TestAmedca <br /> 880 Riverside Parkway <br /> TestAmenca Laboratories,Inc assumes no liability vwth respect to the collection and shipment 01 these samples. I Kr l;A,_-i v,-+.v:er%MN o Ai_ r, <br /> West Sacramento.CA 95605-1500 <br /> phone 916 373-5600 fax 303 467 7248 TestAmerica Laboratorlesr Inc. <br /> Client Contact Information Client Project Manager: -irii Samples Collected By. COC No <br /> Company Name. ^S n [�r�yttl n+ Phone: �Z.Cj �3ry `��QV7 <br /> oY cocs <br /> Address ,Nn a,>,:) EmaiE:K_ <br /> 'r <br /> City/States cLILIa } w For Lab Use Only: <br /> � , �', ° Walk-in Client <br /> Phone Site Contact' -41 <br /> FAX TeUFax�1j 10^-� —t-:-+i 3 r, ,� S Lab Sampling <br /> Project Name. LU--y p LA Y Ana Isis Turnaround Time <br /> J `• <br /> Sit /Location: ; 1140 0 n C41'r StandardS ecdic d o z Job I SDG No <br /> P O d j--Ls:I C I 7, Rish(specfiyp a A e <br /> (See below for Add'I Items <br /> Canister Canister Flaw w ±" m m ig a o 6 <br /> Sample Time Sample Time Vacuum in Vacuum in Canister ('� in V n .9 <br /> Sample Identification Controller s/ a w � a y _ <br /> Stan Date Start End Date Stop Field,"Hg Field."Hg 1D 14 Y r n n 2 m 4 R -a `m <br /> (Start) [StaPt O O w w a w t b ii 0 o t <br /> ut 5 (n m cn � o Sample Speck Nates: <br /> IISS LO/11I`t i z-Or, 30-2-3 ;-�a� "i S 3yl�cz� X X �. <br /> IROS �3i7 30-0 19 033 3,t c.- I'+% - <br /> v 1�ii 30.48 2; I v 9119' 3400141 <br /> b !} !9 <br /> Tem erasure Fahrenheit) �i <br /> start linterior Ambien II <br /> Stop <br /> Pressure inches of H <br /> Start Interior jAmbient <br /> stop 320-51445 Chain of Custody <br /> Special Instructionsti Requirements&Comments: <br /> qp l S 'A"'.,y am -6?(' rP 0- ; be4l , �,,•�, Jz y t b�.-t z-c,,.�, xy W4..a3, <br /> Samples Shipped by: `i bolvr,ps ��, b Date 1 Time: r ZD1 r 17 x� Samples eceive f f <br /> Samples Relinquish b : Daty I Ti / / Rece' e y: lt /y <br /> Relinquished by: tit i e: L Received by: <br /> Lab Use Only: Shipper Name: Opened by: Condition: <br /> N Form No.CA•C-WI-003,Rev.2.9,dated 9/512018 <br /> N <br /> O <br />