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Chain of Custody Record Page _1 ^ of <br /> Req Due Date (mmlddlyy): Rush TAT: Yes _ No <br /> Facility No: 7049 Lab Work Order Number: <br /> Lab Name Test Amence Facility Address 800 East KetHeman Ln ConsuitantlContractor. Antea Group <br /> Lab Address 17461 Denan Ave, Ste 100, Irvine, CA 92614 City, State, ZIP Code Lodi, CA 95240 ConsultantlContractor Project No 07049CC191 <br /> Lab PM Christian Bondoc Lead Regulatory Agency Address 11010 White Rock Rd, Ste. 140, Rancho Cordova, CA 95670 <br /> Lab Phone. (949) 261-1022 California Global iD No Consultant/Contractor PM Bryan Taylor <br /> Lab Shipping Accnt, FedEx #1103-6633-7 Phone. 425498-7727 Email. bryr an taytornanteagrrouo.com <br /> Lab Bottle Order No, Accountng Mode Provision OOC-BU OOC-RM Email EDD To. see special instructions <br /> Other Into- Stage Activity Invoice To. Contractor X <br /> Matrix No. Containers 1 Preservative Requested Analyses f0ata <br /> e & QC Level <br /> dard _ <br /> � kage — <br /> w <br /> � r <br /> h <br /> 3 O <br /> o n <br /> p z <br /> a <br /> o. Sample Description Date Time Comments <br /> M0o J z a m <br /> 0) VJ ca o Z rn V c m a <br /> J _ :: > E R n O* O � L0 Co o � [ p �„' notcollected, indicate " out <br /> R <br /> Q ' !- 2 x z Co $ m N lti MfnNi:iFpt�5lVllM j ) ) <br /> 2 4Ti{, OT/161n ifI ; X n ) z x✓ <br /> Sol - 0 <br /> ry <br /> Of LtWMK 16 )71 y <br /> S.c'_ 'S � l OuD til`A) ? � 7 k X <br /> i <br /> J mw 440-246095 Chain of Custody <br /> X <br /> ti� �- int 4 �• t � �'�� � � � ,� �c <br /> 7 x r Y ( : tnii�l�x <br /> t 1 - 2 _ ztwtn tlfo L 5oCA <br /> k X <br /> Samplers Name 1 Clj �n �; q� Relinquished By l Affiliation Date Time Accepted By l Affiliation Date Time <br /> Sampters Company Antea Group 7 42 i <br /> Shipment Method FedEx Ship Date. " l <br /> Shipment Tracking No ' + !It <br /> \ cial instructions: Email EDF to bryan tayior@anteagroup coin, tan treat@anteagroup com, and AGDataView.US@anteagroup com a . Q 7L /� •��J a <br /> THIS LINE - LAB USE ONLY Custody Seats In Placees / 0 Temp Blank: Yes fNo Cooler Temp on Receipt "FIC trip Blank es No MSlMSD Sample Submitted. Yes , o <br />