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Chain of Custody Record Page of Q <br /> Req Due Date (mmlddlyy): Rush TAT: Yes No <br /> Facility No: 7049 Lab Work Order Number: <br /> Lab Name Test America Facility Address 800 East Kettleman Ln Consultant/Contactor 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 /> Lab PM Christian Bondoc Lead Regulatory Agency. Address. 11010 Whde 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. bin an tavlori anteagrouo com <br /> Lab Bottle Order No Accounting Mode Provision OOC-BU OOC-RM Email EDD To4 see special Instructions <br /> Other Into Stage Activity Invoice To� Contractor X <br /> Matrix No. Containers 1 Preservative Requested Analyses Report Type & QC Level <br /> g Standard <br /> T <br /> w m Full Data Package _ <br /> c M <br /> C� c m <br /> 3 U <br /> =b00 <br /> Sample Description Date Time a o z = n Comments <br /> v 2 Mot <br /> co = ro a rp co M in c ro Note Nsampie not collected, and este "Na <br /> Sample" m comments and single-stnke out <br /> N 4 `—° H S _ _ Co m N and mitral any preprinted sample <br /> pL2 2_ ZatgO? �� 7 t6 ' 12 {? x n 7 X X <br /> 1 <br /> ' A 15 k7Z <br /> Sampler's Name - �`� l0.'i` Relinquished By I Affiliation Date Tlme Accepted By 1 Affiliation Date Time <br /> Sampier's Company Antea Group dab Cot ( L <br /> Shipment Method FedEx Ship Date 7 ,"t t ff2 �f <br /> Shipment Tracking No I <br /> ecial Instructions : Email EDF to bryan tayior caanteagroup om, ran treat@anteagroup com, and AGDataView US o@anteagroup.com <br /> THIS LINE - LAB USE ONLY Custody Seals In Place es I N Temp Blank Yes ! o Cooler Temp on Receipt. °F!C Trip Blank Yes 1 No MS/MSD Sample Submitted Yes No <br /> Q0 <br /> zt, <br />