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Irvine <br /> 17461 Derian Ave j� j' + ,y TestAmedca <br /> .Suite 100 Chain Ol Custody Record THE LEADER IN ENVIRONMENTAL TESTING <br /> Irvine,CA 92614 <br /> phone 949.261.1022 fax 949.260.3299 0) TestAmerica Laboratories,Inc. <br /> Client Contact Project Manager: Site Contact: Date: 20ftp COC No: <br /> Nahid Toossi TeVFax: lab Contact: Amy Harris Carrier. _1_ of—l— 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 /> T' g _ .� 2 weeks 3 fie. SDG No. <br /> Project Name:O'Reilly O 1 week <br /> Site:Store 4666(2801 South Bristol Street,Santa Ana,CA 92704) D 2 days <br /> P O# a l day Effi <br /> F W <br /> Sample Sample u of a <br /> Sample Identification Sample Date Time Type Matrix Cont F v I Sample Specific Notes: <br /> Brake Shaving 3/10/2016 S 1 6 i.l k, Solid I X X X <br /> (D <br /> N <br /> N <br /> 440-140715 Chain of Custody <br /> Preservation Used: 1=Ice, 2=HCl; 3=H2SO4; 4=HI 103; 5--NaOH;6=Other <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than t month) <br /> 0 Non-Hazard 0 Flammable 0 Skin Irritant Poison B '—Y/nknown Retum To Client X Disposal By Lab 0 Archive For Months <br /> Special Instructions/QC Requirements&Comments: <br /> Relinquished by: Nahid Toos i Company:Safety-Kleen Date/Time: Rece� by: Co any : DatelTime: <br /> ii 3/10 I�a `U �� n 1 YbG. �> ��C�- • gyp. Cr' LD <br /> Relinquished by: Company: Date/Time: Received bA N Company: Date/Time: <br /> S:. <br /> \linquished by: Company: Date/Time: Received by: Company: Date/Time: <br /> fV <br /> O <br /> y� �fl <br />