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Chain of Custody Number: b I <br /> Stantee Chain-of Custody Record <br /> Field Office: 077 Sacramento I3 Additional documents are attached, and are part of this Record. <br /> Address: 3017 Kilgore Road, Suite 100 Job Name: 7-Eleven Store#14113 <br /> Rancho Cordova, CA Location: 3040 W. Benjamin Holt Drive <br /> Stockton, CA <br /> Project# 77EL.14113.28 Task# 0403 Analysis Request <br /> Project Manager Damon Brown <br /> Laboratory Kiff Analytical 9 _ a <br /> m C a e <br /> Turnaround Time 24-Hour TAT a g o <br /> a x Z �N a m g SA ttPLE RECEIPT <br /> m o g a = 80 > o z : $ m m Tamp OC `1 Therm.ID Sa-( <br /> Sampler's Name Coli v a <br /> o o !To - o , a m n a 181118 Date 01.O5Oy o <br /> Sampler's Signature m E o d N m o > H m Q m W `w <br /> oa = < $w E m = Tlme 3 CGmI[nnpnWent:�/Xo E <br /> Sample ID Date Time Matrix i ° m w° Instructions z' <br /> CP- -Zlqlq 745 0i 1 <br /> O 9:Lb Ioz <br /> P-I -1S 4:30 v3 <br /> 9:; 1 T <br /> I `d <br /> ,P -2-1 o 1 1116 I vy <br /> P-i-1 U z5 <br /> lo:2aX X 7 <br /> -3-10 /0st5 ° <br /> P-3-15 10,30 <br /> Special Instructions/Comments Relinquish Received by: Sample Receipt <br /> 5 Oxygenates - MtBE, ELBE, DIPE, TBA, TAME Sign Sign Total no.of containers: <br /> 1,2-DCA= 1,2-dichioroethane Print Colin Rydfi Print Chain of custody seals: <br /> EDB = 1,2-Dibromoethane Company Stantec Company Rec'd in good condition/cold: <br /> TPHo= total petroleum hydrocarbons as motor oil Time 4:W DatE Time a Conforms to record: <br /> email tab report to damon.brown@stantec.com, Relinquished by: Recei y: <br /> patrick.herrmann@stantec.com and Sign n � Client: Statnec <br /> patrick.schiller@stantec.com Print Print Client Contact: Damon Brown <br /> Company Company A A,1, Client Phone: (916)861-0400 <br /> Ti Date Time pS� Date v5 ext. 230 <br /> aF a.. z90 Date: L.�Ito9 Page 1d� d-^2� <br />