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Page _1 _ of _1 _ <br /> ,i N <br /> Re Due Date mmlddlyy): Rush TAT: Yes No <br /> BP Site Node Path: q ( �— <br /> BP Facility No: 7049 Lab Work Order Number: ( 1 ' t f o <br /> N <br /> Lab Name: Test America Facility Address: 800 East Kettteman Ln Consultant/Contractor, Amea Group N <br /> Lab Address: 17461 Derian Ave, Ste, 100, Irvine, CA 92614 City, State , ZIP Code: Lodi, CA 95240 ConsultantlContractor Project No: 07049CG191 00 <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 Cadifornia Global ID No.: ConsuitantfContractor PM: Bryan Taylor <br /> Lab Shipping Accnt FedEx #1103-6633-7 Enfos Proposal No: Phone: 425-498-7727 Email: brvan tavlorfaanteagrouo com <br /> Lab Bottle Order No: Accounting Mode: Provision OOC-BU OOC-RM Emalf EDD To: see special instructions <br /> Other Info: Stage: Activity: Invoice To: BP/ARC _ Contractor X <br /> BP Project Manager (PM): Matrix No. Containers 1 Preservative Requested Analyses Report Type & QC Level <br /> BP PM Phone: Standard <br /> BP PM Email m n Full Data Package _ <br /> `✓ <br /> h <br /> 3 0 0 ma' S 4 <br /> Z <br /> n C o X E t00 <br /> o w O <br /> Lab Sample Description Date Time d Cr `o 'Q Z a F N �- Comments c� <br /> No. z °� Q °' S U o <br /> m c k1l caO y o }Q �` Note: If sample not collected, indicate "No (p <br /> o Q o a U m [J 1C�� 1\3 Sample" In comments and single str ke out N <br /> rp 3 Q I— S Z x M m m lc+— l0 and initial any preprinted sample <br /> F / _ y i) <br /> 1 1 � E � � t 1tG25 X n t � x f" yl 6�1 11 <br /> s}t e t txl { _2o i9t5� 1G 7 tiG E S�, Vl $ X >L <br /> mre o eerrneores received <br /> s�� .'>� 1� Zc3t9t t6 7 6 iso IKI <br /> XV IL <br /> .�� <br /> Tfi <br /> 440-77771 Chain of Cust _ ;.. <br /> Sampler's Name: tan Treat tiro �i `L2 Reli wished By ! Affiliation Date Time Accepted By 1 Affiliation Date Time <br /> liiiimwm�10 I'm <br /> Sampler's Company: Antea Group G7 <br /> Shipment Method: FedEx Ship Date: "1 769 <br /> Shipment Tracking No: 77 \ 1V V lqJIfS119J <br /> Special instructions. EDF must be in BP forn at Email EDF to bryan.taylor@arrteagroup.com, ian.treat@anteagroup.com, AGDataView.US@anteagroup.com ----�"� <br /> THIS LINE - LAB USE ONLY: Custody Seals In Plac : Yes o Temp Blank: Yes No Cooler on Receipt: Z �? 'FlC Trip Blank Yes No MS/MSD Sample Submitted: Yes No <br />