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Irvine TestArnerica <br /> 17461 Derian Ave <br /> Suite 100 Chain of Custody Record <br /> THE LEADER IN EN V14o NM ENTAL TESTING. <br /> Irvine,CA 92614 <br /> phone 949.261.1022 fax 949.260.3299 4[. TestAmerica Laboratories,Inc. <br /> Client Contact Project Manager. Site Contact: Date: # 3 �Tj COC No: <br /> Nahid Toossi _ Tel/Fax. Lab Contact: Amy Harris Carrier: _1_ of-1. COCs <br /> 2120 S.Yale Street Analysis Turnaround Time Job No. <br /> Santa Ana,CA 92704 Calendar(C)or Work Days(W) W <br /> 714-429-4355 TAT if different from Below_5 days <br /> 2 weeks 3 v\ $ C/ SDG No. <br /> Project Name:O'Reilly D 1 week S* <br /> Site:Store 4666(2801 South Bristol Street,Santa Ana,CA 92704) O 2 daysr <br /> P O# 31-2 �Q C7 1 day ffi <br /> n <br /> 5at1 CA T210\) Sample Sample a of <br /> Sample Identification Sample Date Time Type Matrix Cone <br /> '"� r U a Sample Specific Notes: <br /> Brake Shaving 3/10/2016 �; Solid 1 X X X <br /> Q <br /> i! <br /> 440-140711 Chain of Custody <br /> Preservation Used: 1=Ice, 2=HCI; 3=H2SO4; 4=HNO3; —r—NaOH;6=Other _ —T---r— — — — — <br /> Possible Hazard IdeWijgeation Sample Disposal(A fee maybe assessed if samp/ens are retained longer than 1 mq�try) <br /> Non-Hazard Q Flammable 0 Skin Irritant Poison B =Unknown 0 Return To Client X Disposal By Lab Archive For Months <br /> Special Instructions/QC Requirements&Comments: <br /> Relinquished by: Nahid Toossi Company.Safety-Kleen Date/Time: Received y: C�mWy: Date/time: <br /> arra 3/e •.n 0 r0►, <br /> Relinquished by: Company: Date/Time: Received by: Company: Date/Time: <br /> elinquished by: Company: Date/Time: Received by: Company: Date/Time: <br /> .10 <br /> CA rly <br />