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Eurofins TestAmerica, Sacramento <br /> eurofins <br /> 880 Riverside Parkway Envuu <br /> West Sacramento. CA 95605 Chain of Custody Record TestAf, <br /> Phone(916)373-5600 Fax(916)372-1059 <br /> Sampier Lab PM Carrier Tracking No(s): COC No: <br /> Client Information Devon Owens Cisneros,Roxanne <br /> Client Contact. Phone E-Mail: Page:rr <br /> Pat McConnell roxanne.cisneros�testamencalnc.com Page( V <br /> Company: Job# <br /> Stantec Consulting Services,Inc. Analysis Requested <br /> Address: Due Date Requested: Preservation Codes: <br /> 9665 Granite Ridge Drive Suite 220 <br /> A-HCL M-Hexane <br /> City: TAT Requested(days): <br /> B-NaOH N-None <br /> San Diego C-Zn Acetate O-AsN902 <br /> State,Zip: Standard D-Nitric Acid P-Na204S <br /> CA,92123 E-NaHSO4 Q-Na2SO3 <br /> F-McOH R-Na2S203 <br /> Phone: PO#: <br /> G-Amchlor S-H2SO4 <br /> 858-633-4222 NON ENFOS:Invoice Stantec AP/cc P.McConnell H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO# Z m <br /> 1-108 U-Acetone <br /> Pat,McConnell@stantec.com `o o a J-DI Water v-MCAA <br /> m Z `!' K-EDTA W-pH 4-5 <br /> Project Name Project `o i. L-EDA Z-other(specify) <br /> 7-Eleven Store No.41531 (1046254) 185850913 m o o <br /> Site SSOW#: m oo Other: <br /> 3379 North Tracy Boulevard,Tracy,CA rn y f o — <br /> X <br /> Sample Matrix m m o t E <br /> Type (w=wna,. p O O <br /> YP s=,o,d LL C X u XZ <br /> Sample (C=Comp, o„aa anon. <br /> Sam le Date Time G=grab) m <br /> Sample Identification p 9 ) e.=u s a.a=A..) iI li Special Instructions/Note: <br /> N Preservation Code: X X A I A I I <br /> N <br /> o S[ /• ` &W O W <br /> 0 <br /> s <br /> U—7 — w 6(3-L,7 G W <br /> 1? <br /> S — ' 6-Vf/ V G W <br /> I <br /> 320-59973 Chain of Custody <br /> Possible Hazard Identification Sample Disposal(A fee may�beassessed if samples are retained longer than 1 month) <br /> � fiIon-Hazard Flammable =Skin Irritant Poison B Unknown Radiological =Return To Client 'Disposal By Lab Archive For Months <br /> Deliverable Requested:I,Il,III,IV,Other(specify) Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by: Date. Time: Method of Shipment <br /> Relinquished /f� S Daterrime. r 1�� L Company Received by: DateRime. — Company <br /> Relinquished by: Daterrime:r Company Wceived by: Date/Time. Company <br /> r,O Relinquished by: Date/Time: Company Received by Date/Time Company <br /> N <br /> ON Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)"C and other Remarks/ <br /> o A Yes A No <br /> \let 0l 16 tole <br />