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7 <br /> Page � 1' of <br /> Chain of Custody Record , <br /> Req Due Date (mmlddlyy) : Rush TAT: Yes . No <br /> Facility filo: 7x43 Lab Work Order Number: <br /> Lab Name Test America Facility Address 800 East Kettleman Ln Consultant/Contractor Antea Group <br /> Lab Address 17461 Denan Ave, Ste 100, Irvine, CA 92614 City, State, ZIP Code Lodi, CA 95240 Consultant/Contractor Project No. 07049CC191 <br /> ddress t t010 White Rock Rd, Ste 140, Rancho Cordova, CA 95670 <br /> Lab PM. Christian Bandoc Lead RegulatoryAgency Oc H l] <br /> Lab Phone (949) 261 -1022 Cairtomia Global ID No Consultant/Contractor PM Bryan Taylor <br /> Lab Shipping Accnt. FedEx #1103-6633-7 Phone: 42549&7727 Email: Aryan tavlor0anteaomuo corn <br /> Lab Bottle Order No: Accounting Mode, Provision OOC-BU OOC-RM EmailEDD To see special instrtrctions <br /> Other Into Stage Activity invoice To- Contractor X <br /> Matrix No. Containers t Preservative Requested Analyses Report Type & QC Level <br /> o Standard <br /> ro Full Data Package — <br /> c � <br /> f � m <br /> m `o <br /> Lab Sample Description Date Time a a v a ¢ 0 Comments <br /> No. g z a $ o c7 a J <br /> > N Z m O a) ITS m U Note If sample not collected, indicate "No <br /> o _ a ty Z U m o Sample" m comments and sint;Wstnke out <br /> or 'S Q tl1 H 7 x Z 2 m m m 1 N i and inNai arty preprinted sample <br /> ~z z6 C 6 ? 6 R - i 5 X n <br /> QL 4- - � .ZZ <br /> ZsP _ rLg Z _ 190? tb t3 & �t 7 ! X X <br /> Of U z_ t3 $ 7 X x x <br /> MiesY!7 Z _ <br /> x0163 Z _ te, I I ti ifo m%o3q S . 7 ! X k y X <br /> �15P3 _ PLIb 2 _2ctRc`i1G n 7 1 1 1t XX <br /> Sampler's Nameka ��� D � Q Relinquished By i Affiliation Date Time Accepted By J Affiliation Date Time <br /> Sampler's Company. Antea Group <br /> v <br /> Shipment Method FedEx Ship Date Ag <br /> j <br /> Shipment Tracking No t p V <br /> pecial htstructions: Email EDF to bryan taylor@anteagrou om, lan,treat(ganteagroup com, and AGDataView US@anteagroup com <br /> No r <br /> THIS LINE - LAB USE ONLY. Custody Seals In Place Yes No Temp Blank Yes I o Cooler Temp on Receipt, "F/C Trip Blank es No MS/MSD Sample Submftted• Ye I <br />