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1 �D <br /> b�3 Laboratory Management Program (L��MP) Chain of Custody Record c240 L 0 <br /> Soil, Sediment and Groundwater Samples Page of <br /> Req Due Date(mm/dd/yy): Rush TAT Yes X No <br /> BP Facility No: ARCO 2093 Lab Work Order Number: <br /> Lab Name: Pace National BP/ARC Facility Address: 3425 Tracy Blvd North Consultant/Contractor: Antea Group <br /> Lab Address: 12065 Lebanon Road,Mt.Juliet,TN 37122 City,State,ZIP Code: Tracy,CA 95376 Cons ultant/Contractor Project No: BP M&C 2093 <br /> Lab PM: Brian Ford Lead Regulatory Agency: San Joaquin County-Enviromental Health Address: 11010 White Rock Rd,Suite 140,Rancho Cordova,CA 95670 <br /> Lab Phone: 615-773-9772 Department Consultant/Contractor PM: Brad Jackson <br /> Lab ShippingAccnt: Phone: 971-777-0241 Email: Brid:Jackson_AnteaGroup.us <br /> Lab Bottle Order No: Send/Submit EDD to: Brad Jackson,Antea Group <br /> Other Info: ANTEARCCA-2093 <br /> Invoice To: Antea Group <br /> BP/RM PM: Griff Williamson Requested Analyses Report Type&QC Level <br /> PM Phone: 805-794-6847 N N N N N N Limited Standard Package x— <br /> Filtered(YIN) (Standard) 9 <br /> PM Email: (rlffln.WllllamSODanbp.COrn Preservation N N N N N N Limited Plus Package <br /> o Full Package— <br /> v w w <br /> c a <br /> v <br /> C W P � O <br /> Unique Sample ID,must follow format of COMP NUMBER YYYYMMDD o CO N o <br /> Lab — — <br /> No Example: Time E o a _ d <br /> COMP_1_20220608 u v m m m 2E w <br /> T Comments <br /> E `o E d a a <br /> �? z N aaw w C <br /> L - X ~H a J <br /> Q. 'c U U uJ m 0 U <br /> O O m I -' <br /> D l7 > >w m (D H U) I' <br /> COMP-1_20230417 839 Ft G 6 S X X X X X Hold for STLC/TCLP C, <br /> COMP-2_20230417 848 Ft G 6 S X X X X X Hold for STLC/TCLP <br /> Trip Blank 900 2 W X X X X <br /> Sampler's Name: Emily Hudak Relinquished By I Affiliation Date Time Accepted By/Affiliation Date Time <br /> Sampler's Company: Antea Group 'r 64 � !1/ 23 '�?,/� �9 <br /> Ship Method: Fed-Ex Ship Date: i 7 � .V <br /> Shipment Tracking No: <br /> Special Instructions: VOCs include:MTBE,DIPE,EtBE,TAME,TBA,1,2-DCA,EDB.and BTEX <br /> THIS LINE-LAB USE ONLY: Custody Seals In Place:Yes/No I Temp Blank:Yes/No Cooler Temp on Receipt: °F/C Trip Blank:Yes/No I MS/MSD Sample Submitted:Yes/No <br /> Sample Receipt Checklist <br /> COC Seal Present/Intact:/YN If Applicable <br /> COC Signed/Rccurate: VOA Zero Headspace: _`l_Pd <br /> Proprietary and Confidential Bottles arrive intact: 7,,' N Pres.Correct/Check: _Y_Td <br /> Property of BP and its Affiliates Correct bottles used: —/Y DI �v` 1. �0 �•� <br /> Sufficient volume sent: 7;_P7 6Z& VA 6160 coo <br />� PAD Screen <0.5 mR/hr: �YIQ J <br />