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Eurofins TestAmerica, Sacramento <br /> 880 Riverside Parkway ('t!f(1111l" <br /> West Sacramento, CA 95605 Chain of Custody Record <br /> Phone(916)373-5600 Fax(916)372-1059 <br /> Sampler Lab PM Carrier Tracking No(s) COC No <br /> Client Information Devon Owens Cisneros,Roxanne <br /> Client Contact Phone. E-Mail: Page <br /> Pat McConnell (408)656-6326roxanne.cisneros(d,)testamericainc.com Paged of 2- <br /> Company <br /> -Company. <br /> 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 /> 8-NaOH N-None <br /> San Diego C-Zn Acetate O-AsNa02 <br /> State.Zip Standard D-Nitric Acid P-Na204S <br /> CA,92123 E-NaHSO4 O-Na2SO3 <br /> F-McOH R-Na2S203 <br /> Phone PO# <br /> G-Amchlor S-1-12SO4 <br /> 858-633-4222 NON ENFOS,Invoice Stantec AP/cc P.McConnell _ N H-Ascorbic Acid T-TSP Dodecahydrate <br /> o <br /> Email WO# Z m I-Ice U-Acelone <br /> Pat.McConnell@stantec.COm o o a J-DI Water v-MCAA <br /> h Z w m K-EDTA W-pH 4-5 <br /> Project Name Project# > 0 L-EDA Z-other(specify) <br /> 7-Eleven Store No.41531 (1046254) 185850913 m o p <br /> C <br /> Site. SSOW# E r m o 0 o Other, <br /> 3379 North Tracy Boulevard,Tracy,CA rn U) o 0 <br /> Sample Matrix 2 m o E <br /> Type (W—.r., LL € �° i <br /> s=.oim, <br /> Sample (C=Comp, 9 h <br /> Sample Identification Sample Date Time G=grab) .—I.—A=An) a ais � u- - t° Special Instructions/Note: <br /> Preservation Code: I I I <br /> G S <br /> ON �j 1G S <br /> w <br /> - -I G S <br /> w - <br /> G S <br /> G S <br /> G S <br /> G S <br /> G S <br /> G S <br /> G S <br /> G S <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 0 Non-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/OC Requirements: <br /> Empty Kit Relinquished by Date: Time: Method of Shipment. <br /> Relinquished b:�'?,�' Date/Time Company Recei ed by / Date/Time: Company <br /> ct�^^'LT1Yl - <br /> Relinquished by Date/Time. Company Wcenied by: Date/Time: Company <br /> co Relinquished by DaterTime Company Received by DaterTime: Company <br /> N <br /> CD Custody Seals Intact Custody Seal No.. Cooler Temperature(s)°C and Other Remarks ( ( (JJC <br /> N y Yes No `` ?'� <br /> CD <br /> Ver:01/16/2019 <br /> __ _ n n n n � <br />