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BOaa <br /> by Laboratory Management Program (LaMP) Chain of Custody Record <br /> Soil, Sediment and Groundwater Samples Page_1_ of <br /> Req Due Date(mm)ddlyy): Rush TAT Yes X No <br /> BP Facility No: ARCO No IV � Lab Work Order Number: <br /> Lab Name: Pace National BP/ARC Facility Address 3425 Tracy BW North Consultant/Contractor Antea Group <br /> Lab Address: 12065 Lebanon Road,Mt.Juliet,TN 37122 City,State,ZIP Code: Tracy,CA 95376 ConsuhanUContracior 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 Consuffant/Contractor PM: Brad Jackson <br /> Lab Shipping AccnP -jackson(@AnjgLQrou2.us <br /> 971-777-0241 Email Brad <br /> Lab Bottle Order No: Send/Submit EDD to: Brad Jackson,Antea Group <br /> Other Info: ANTEARCCA-2093 linvoice To: Antea Group <br /> BP PM: Griff Williamson Requested Analyses Report Type&QC Level <br /> PM Phone: 805-794-6847 FdtereG(YIN) N N N N N Limited(Standard)Package x— <br /> PM Ema'dL J.dy.Go preservaton N N N N N Limited Plus Package <br /> C6 Full Package— <br /> y ur w <br /> u <br /> ui Q m o <br /> o m� <br /> Lab Unique Sample ID,must follow format of u _U F- z $ <br /> COMP_NUMBER_YYYYMMOD Example: Time E d a <br /> No. COMP 1 20220608 u° $ $ Comments <br /> L7 z n n,h n <br /> T O 11 <br /> X 1 �O <br /> a O O m n o iLX// <br /> 7 U, m 0 H <br /> UDC-1_20230412 Ft G 6 S X X X X {� <br /> UDC-2_20230412 0 Ft G 6 S X X X X � QZ <br /> UDC-3_20230412_'k4.0 Ft G 6 S X X X X <br /> UDC-4-20230412,,.3. I S W)3 Ft G 6 S x X x x f <br /> PL-1_20230412-.43-75 a Ft G 6 S X X X X 00 <br /> PL-2_20230412 } rt G 6 S X X X X a <br /> PL-3_20230412 1W R G 6 S X x x x <br /> Sampler's Name: Avery Knizek Relinquished By I Affiliation Date Time Accepted By I Affiliation Date Time <br /> Samplers Company: Antea Group Lj '! '; I <br /> Ship Method: Fed-Ex Ship Date: , }+ <br /> Shipment Tracking No: V <br /> Special Instructions: V(5Cs include:MTBE,DIPE,ELBE,TAME,TBA,1,2-DCA,EDB.and BTEX <br /> THIS LINE-LAB USE ONLY Custody Seals In Place:Yes I No I Temp Blank:Yes 1 No I Cooler Temp on Receipt:_'FIC I Trip Blank.Yes i No MSIMSD Sample Submitted,Yes 1 No <br /> BP LaMP Suiln120 COC March 2019 <br /> :,am le Tecei.I 'uecklist <br /> COC Seal Preaent ir,ta^�.: r If Applicsb <br /> CCC Signed/Accurata; ')A Zero Headspace: _Y 1d Proprietary ondConfidential <br /> Bottles arrive intact: Fre9.Cerrect/Check: ^Y 1d <br /> Correct betties used: td r Property of BP and its Affiliates <br /> Sufficient volume sent: �» 'I ail��d <br />