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�C�-t 1 l LI <br /> TestAmerica Sacramento Canister Samples Chain of Custody Record TestAmerica <br /> Riverside Parkway <br /> TestAmerica Laboratories,Inc.assumes no liability with respea to the toile tion and shipment of these samples. THE LEADER IN ENVIRONMENTAL rESTiNG <br /> West Sacramento,CA 95605-1500 <br /> phone 916.373.5600 fax 303.467.7248 TestAmerica Laboratories,Inc. <br /> Client Contact Information Client Project Manager:Jonni Martin Samples Collected By: COC No: <br /> Company Name:GHD/UPRR Phone:916-347.8655 of CDCs <br /> Address:1000 Roth Rd Email:MARTINJ@PATRIOTENVIRONMENTAL.CO g <br /> City/State/Zip French Camp Ca 95231 w For Lab Use Only: <br /> Phone:916-347-8655 Site Contact:Jonni Martin .'v'»' ° Walk-in Client <br /> FAX: Tel/Fax 916-347-8655 ° w Lab Sampling: <br /> Project Name:11-19-00173 Ana Isis Turnaround Time o N <br /> Site Location:French Camp Standard S ecific: N a o Job!SDG No.: <br /> P O#WR#21633 Rush S ecifi 2 Da m <br /> ( p Y)_ y c o N a L (See below for Add'l Items) <br /> Canister Canister r3 c c m $`; Q w m <br /> Vacuum Vacuum Flow g H o �n m <br /> Sample Time Time Canister v , a a <br /> Sample Identification m Field, in Field, Controller ^ '� o < m ,�, A a <br /> Date(s) Start Stop .Hg 'Hg ID ID 7 -7 v ° ur 0 > v m <br /> (Start)' (Stop)' o o N O F v v) io w S Sample Specific Notes: <br /> 001 X X X X X Please see Special Requirements <br /> 002 1 IX X X X X Please see Special Requirements <br /> v <br /> r� <br /> (D <br /> W <br /> A <br /> O_ <br /> W <br /> J <br /> 720-93886 Chain of Custody <br /> To erature Fahrenheit <br /> m <br /> Start Interior Ambient <br /> Stop <br /> Pressure inches of H <br /> Start Interior Ambient <br /> Sto <br /> Special Instructions/QC Requirements&Comments: "Please Run 96 hour Fish Bioassay H TPH Diesel>10,00 mg/kg,TPH Oil>10,00 mg/kg TPH Gasoline>5,00 mg/kg•• <br /> Samples Shipped by: Date/Time: S` ((y Samples Received b . I h 44_11_� ((L13 <br /> SamD799 R�ir) ish d.tjy: , C Da e l !Te !4 Received by: <br /> RelMquished by: I Date I Time: V Received by: L. <br /> "ate- Y <br /> ". rtr, 'w".. .� `.rr'' �`1, '! a �;a�ar•z { .'r t,5t, c ;s,�.�;; `-, J% .. '��cr. i <br /> v <br /> Form No.CA-C-WI-003,Rev.2.6,dated 9/2712017 <br /> k4 1 G.v>nt tit VO <br /> 0 <br /> 0;z <br /> B <br />