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TestAwica Sacramento Chain of Custody Record <br /> Wo iUverside TestAmedca <br /> THE LEADER IN ENVIRONMENTAL TESTING <br /> UeEk lacrane!Vco., CA 95L-DS TestArnerica Laboratories,Inc. <br /> Movie- 9116.373.56H Fu: Regulatory PrograrnK F1 DW [_1 NPDES E]RCRA []Other: TAL-8210(0713) <br /> Client Contact Project Manager: �,4 §lte Contact: 4'. bate: • COC No: <br /> Carrier: -9 of Cocs <br /> Company Name: Tel/Fax: Lab Contact:a <br /> )16 K und Time Sampler:"�. " Analysis Turnaro <br /> Address, WORKING DAYS For Lab Use Clnly� <br /> Walk-in Client: <br /> CALENDAR DAYS <br /> City/State/Zip: j'L7�), I t� <br /> Phone: TAT if different from Below Lab Sampling. <br /> Fax: EI 2 weeks <br /> Project Name: teL_7A,7AJY_ El 1 week <br /> Site: 2 days <br /> Job SDG No.: <br /> PO# El I day E <br /> Sample W <br /> Te <br /> Sample Sample (C=co mp, #of =a) t <br /> Sample Identification Date Time G=Grab) Matrixi Cont CL, I Sample Specific Notes: <br /> I I I I I I I <br /> 42 31 1_1 I 1 11 <br /> 1+ 1 1+ <br /> Preservation Used: 1=lce, 2=HCl; 3=H2SO4: 4--H N 0 3; 5--Na 0 H:6=Other 4�4 11 <br /> Possible Hazard Identification: Sample Disposal(A tee may be assessed if samples are retained longer than I month) <br /> Are any samples from a listed EPA Hazardous Waste? Please List any EPA Waste Codes for the sample in the <br /> Comments Section if the lab is to dispose of the sample. I []Archive for Months <br /> 7 Non-Hazard C]Flammable [D Skin irritant ❑Poison B El Unknown LJ Return to Client ❑Disposal by Lab <br /> Special Instructions=Requirements&Comments: <br /> Custody Seals Intact, Q Yes No Custody Seal No,: [CoolarTemp.( Cy: bSd!— Cor- DatelTime.r d:_ Therm 10 N-No,: <br /> Relinquished by: Company: Date/Time Received by:. Company: <br /> L <br /> Relinquished by: Company: Date/Time Received by:'. e Company: DatelTime: <br /> Relinquished by: Company: Date/Time: Received in Laboratory by: [Company: Date/Time: <br />