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i estHmerlca lrulne Chain of Custody Record TestAmedca <br /> 17461 Derian Ave 057794 <br /> Suite 100 <br /> THE LEADER IN ENVIRONMENTAL TESTING <br /> Irvine, CA 92614 TestAmerica Laboratories,Inc. <br /> Phone: 949.261.1022 Fax: Regulatory Program: ❑Dw ❑NPDES ❑RCRA ❑Other: TAL-8210(0713) <br /> Client Contact Project Manager: Site Contact: Date: COC No: <br /> Company Name: / p //,1 {� Tel/Fax: Lab Contact: Carrier: of CDCs <br /> Address: R (_�In /:Ili Analysis Turnaround Time Sampler: <br /> Cilyistale0tp: t2 _: �'' J CALENDAR DAYS u wQRK1NG.DAYS For Lab Use Only: <br /> Phone: TAT if different from13yfOah 1, Z Walk-in Client: <br /> Fax: El we4 Z } Lab Sampling: <br /> PmjeO Narste: r.r.^ I j - ❑ 1 week r } <br /> Site: ❑ z days ;, (0 ,':Z�j Job/SDG No.: <br /> PO# ❑ 1day E rn <br /> Sampie rn g <br /> E <br /> Sample Sample (c==comp, III of d °t <br /> Sample Identification Date Time G=Grab) Matrix Cont. LL li Sample Specific Notes: <br /> 73 <br /> Preservation Used: 1=Ice, 2=HCI; 3=H2SO4; 4=HNO3; S=NsOH;6=Other <br /> Possible Hazard Identincation: Sample Disposal(A fee may be assessed if samples are retained longer than 1 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.. <br /> Non-Hazard ❑Flammable ❑G Skin Irritant L7 Poison B ❑Unknown ❑Return to Client ❑Disposal by Lab ❑Archive for Months <br /> Special Instructions=Requirements&Comments: <br /> Custody Seals Intact: ❑ Yes ❑ No Custody Seal No.: lCooler Temp.("C).Qbs'd. carr(L Therm ID No.. <br /> Relinquished b`y: / �J Compan C t imea Received by: Company: 0 tern- e: r <br /> �/ �, r� t Fed 3 fl 2 <br /> Relin ulsh d by: L Company: ale/Tirrier Received by: Camp�C%% Date/Tim : / <br /> `�"`" <br /> :Relinquished by: Company: Date/Time: Received in Laboratory by: Company: J Date/Time: <br />