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TestAmerica Sacramento {- Ieinca <br /> may ./�/'y <br /> 880 Riverside Parkway Tes A ( <br /> West Sacramento, CA 95605 Chain of Custody Record <br /> Phone(916)3735600 Fax(916)372-1059 TIC l.CADCR IN t NVW0NHFNTAI TCRTING <br /> Sampler. Lab PM: Carter Tracking No(.): COC No: <br /> Client Information Sub Contract Lab laver,Unda C. 320.28681.1 <br /> Client Contact Phone: E-1,U: ?apo: <br /> Shipping/Receiving linda.Iaver@testamehcainc.com Page 1 of 1 <br /> company. Job A: <br /> TestAmerica Laboratories,Inc. Analysis Requested 320.7388-2 <br /> Addmu: Dua Data Rsqueated: Preservation Codas: <br /> 30 Community Drive, Suite 11, 511912014 <br /> Cly: TAT Roquoatad(days): A-HCL M-HorneB-NOOH N.None <br /> South Burlington C-ZnAceae 0-AaNao2 <br /> State,Zip: <br /> g D-Nhdd Acre P-Na204S <br /> VT,05403 w E-NaHSO4 Q-Na2SO3 <br /> Phone: POS: r - F-M&OH R-NaMS03 <br /> 802-660-1990(Tel) <br /> G-AmWor S-N2504 <br /> p r� H-P:caNale Acid T-TSP Dedocahydrote <br /> F1nat1: WO Yr. Z <br /> � � l-IcaU-Acetone <br /> D J-DI Water V-td CAA <br /> Project No / �, �'I!„r Prnloct T. K-EDTA W-ph 45 <br /> USPS Brake P,ad CharaC.CC,ton_Pa tide 32005618 0 3 L-EDA z-other(spadly) <br /> SI[e; Y SSOW/t: ¢ Other. <br /> 0 <br /> O� o <br /> Sample Matrix d „ $ <br /> 5` i E <br /> Type <br /> (irM.aru. 5 <br /> 3- 11W x z <br /> Sample (CoIcorep, P <br /> Sample IdontMcation-Client ID lab ID Sam le Do Time G- rab) er n..„.,Aw, 3 H° Special lnstructionsiNoto: <br /> v Preservation Coda <br /> to <br /> O IDW-Stockton(320-7388-1) 517!14 B' 0 Solid X 1. <br /> sPedal prep sae CGC_need only <br /> I”) <br /> P CifiC t06um <br /> N <br /> O <br /> N <br /> A <br /> f � I <br /> 320.7 88 <br /> Chain of Custody <br /> Possible Hazard ldentfricatlon Sample Disposal(A fee maybe assessed if samples are retained longer than 1 month) <br /> Unconfirmed =Rotum To Client Disposal$1y Lab =Archive For Months <br /> Deliverable Requested:1,11,III,IV,Other(specify) Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by. Date Time: Mehod of Shipman <br /> i <br /> Re od by-.: Da ral 1- Com <br /> / Ym + R �y� <br /> Reftnquahed byontaTrno: CompanyRocc] Dtafmo: <br /> Company <br /> v <br /> 20 RoMqukhod by. Dotornme: Company R.Wvoel by. Datarnmo: Company <br /> N <br /> O_ <br /> Custody Seals Intact Custody Seal No.: Cootor Ta -W'C and Other Romarko: <br /> a Yes A No <br /> _b <br /> is�q <br />