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6QQa <br /> by Laboratory Management Program (LaMP) Chain of Custody Record <br /> Soil, Sediment and Groundwater Samples Page_1_ of <br /> Req Due Date(mmlddlyy): Rush TAT Yes X No <br /> 0 BP Facility No: ARCO No.,;t y 3 Lab Work Order Number: <br /> Lab Name: Pace National BPIARC Facility Address: 3425 Tracy BNd North ConsultanVContractar. Antea Group <br /> Lab Address: 12065 Lebanon Road,Mt.Juliet.TN 37122 City,State,Z1P Code: Tracy,CA 95376 Consultant/Contractor Project No: BP M&C 2093 <br /> Lab PM Brian Ford Lead Regulatory Agency: San Joaquin County-Enviromental Heaith Address, 11010 White Rock Rd,Suite 140,Rancho Cordova,CA 95670 <br /> Lab Phone: 615-773-9772 Department ConsunantlContractor PM: Brad Jackson <br /> Lab Shipping Accnt Phone 971-777-0241 Email Brad.Jackson(cDAnteaGroua.us <br /> Lab Bottle Order No' Send/Submit EDD to: Brad Jackson,Antea Group <br /> Other Info: ANTEARCCA-2093 Invoice To: Antes Group <br /> BP PM: Grill Williamson Requested Analyses Report Type&QC Level <br /> PM Phone: 805-794-6647 Finered tY" N N N N N Limited(Standard)Package x— <br /> PM Email: Efi "or-@b com Preservation N N N N N Limited Plus Package <br /> Ed <br /> Full Package— <br /> v us w <br /> OU m N o <br /> Unique Sample ID,must follow format of a _ <br /> Lab COMP_NUMBER_YYYYMMDD Example: rime E d a <br /> No . <br /> COMP 1 20220608 $ $ Lu Comments <br /> _ _ `o E m m ui < a <br /> t? i n nw B <br /> C 14 O w d1> O mr'j v 0 10 <br /> CM <br /> UDC-1_20230412 Ft G 6 S x x x x {� <br /> UDC-2_20230412 . 0 I(AZ FI G 6 S X x x x � QZ <br /> UDC-3_20230412A 4.0 Ft G 6 S x x x x -- 03 <br /> UDCA_20230412 r 3.IS, U3 Ft G 6 S x x x x r <br /> PL-1_20230412 .I J Q Ft G 6 5 x x x x CCD <br /> PL-2_20230412_A as <br /> Ft G 6 S x x x x -a <br /> PL-3_20230412 �.0 Ft 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 /> Sampler's Company: Antea Group O af j D C4 ! ..v -1 ++ 1'5 <br /> Ship Method: Fed-Ex Ship Date: <br /> Shipment Tracking <br /> Special Instructions: V(TCs include:MTBE,DIPS,ELBE,TAME,TBA,1,2-DCA,EDB.and VF` <br /> 7H1S LINE-LAB USE ONLY: Custody Seals In Place:Yes 1 No I Temp Bi Yes!No I Cooler Temp on Receipt. *FIC Trip Blank:Yes r`- i MSIMSD Sar ie Submitted:Yes I No <br /> SP LaMP SaiVN20 COC March 2018 <br /> am le Rec:ea 'iaecklist <br /> COC Seal Present;rota^t: r if Applicable <br /> CCC SignedOAccurat`.e: 7')A Zero Headspace: X if <br /> Bcttles arrive intact: ?� I res.�orract/Check: Y_N Proprietaryand <br /> Mates <br /> Correct bottles used: _fd y�1>�� Property of BP and its Aff <br /> Sufficient volume sent: N M 1.7L1��:or <br />