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Chain of Custody Record 3 2 8 7 8 0 TestAmedca <br /> 71[E LEADER IN ENVIRONMENTAL TESTING <br /> TestAmerica Laboratories,Inc. <br /> Regulatory Program: —Dvr C NpDes C RcRA other: TAL-8210(0713) <br /> Client Contact Project Manager: Site Contact: Date: to Tk i COC No: <br /> Company Name: TeilFax: (op s3 - 1Z Lab Contact: , CCYtT . Carder: �_ of COCS <br /> Address: LZ9 iv 'SAwClb :D Analysis Turnaround Time Sampler: <br /> City]StatelZip: 5 iECA CALENDAR DAYS _ WORKING DAYS For Lab Use Only: <br /> Phone: TAT it different from Below 2su z Walk-in Client: <br /> Fax: 2 weeks z y` Lab Sampling: <br /> Project Name: r 4S i week 'y o <br /> Site: S-L- CU [ya 2 daysm > Job!SDG No, <br /> P O# coo = t day CL <br /> E Vl <br /> Sample m f <br /> a E <br /> Tpe <br /> Sample Sample (C-Co p. #of a S <br /> Sample Identification Date Time c=crab) Matrix Cont. ; a in Sample Specific Notes: <br /> C�,RC-.ASE - 4 Ib30 C- i <br /> Cr <br /> i <br /> 320-55647 Chain of Custody <br /> Preservation Used: 1=Ice, 2=HCI; 3=1­12S(04; 4=HNO3; 5=NaOH;6=Other <br /> Possible Hazard Identification: 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 it the lab is to dispose of the sample. <br /> _Non-Hazard J:Flammable C Skin Irritant POisDn B Unknown Return to Client r Disposal by Lab Archive for_ Months <br /> Special Instructions/QC Requirements&Comments: <br /> Custody Seals Intact: res No Custody Seal No.: lCooler 7 mp.( C):Obs'd: orr'd: Therm ID No.: <br /> Relinquished by: Company: DatefTim by: Compan : DatefTime: <br /> NLM LYNN A� 74[I <br /> Relinquished by: Company Datetme: XiCeived Company: Datef7ime: <br /> Relinquished by: Company: DateMme: Receives:in Laborelory by Company: DatefTime: <br /> A ® �i �7Ae •• �1l.� l� l� l� © e <br />