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CHAIN OF CUSTODY / ANALYSIS REQUEST <br />Attention- ---- <br />Mark-Dysert---- — - - - - <br />Phone--- <br />(650)-799-9204 - - — <br />Billing (if different) --- <br />Company Name <br />Dysert Environmental, Inc. <br />Email <br />environmental.data@gmail.com <br />Attn: Accounts Payable <br />Mailing Address <br />P.O. Box 5608 <br />Mobile <br />Dysart Environmental, Inc. <br />City, State & Zip <br />San Mateo, CA 94402 <br />P.O. No. <br />`�'L <br />P.D. Box 5608 <br />Laboratory <br />ANC ` <br />Samplerls <br />L <br />San Mateo, CA 94402 <br />Project <br />Name <br />Pactiv Packaging, Inc. <br />4545 Qantas Lane <br />Stockton, CA 95206 <br />Project <br />Location <br />Pactiv Packaging, Inc. <br />4545 Qantas Lane <br />Stockton, CA 95206 <br />Sampling Code= <br />Pacuv,Jef <br />Sample Matrix = <br />Wastewater <br />Field Notes: <br />a <br />v <br />Turn Around <br />Time = 5 Day <br />Sample ID: <br />Date: Time: No. of <br />Containers <br />O� I x 350mL PL HNO3 <br />1xIL PL NP <br />y <br />R•Ilnqulohby R•c•Ivod by <br />C� 1,., .moo ,. <br />Additional Mailing Instructions: <br />C' <br />R.H. I e y �oc....d by ` Timo <br />i•` ��� I <br />t <br />nquhh•d by R. W.d by <br />T Tim• <br />. O /\ <br />V <br />R•Iinqui•h•d by R•..1 -d by Tlm• <br />0 <br />Lab Notes: Notes: <br />q Please <br />Sample Temperature Upon Recel t In Lab = <br />hold addtl 1L PL NP <br />Page 1 or 1 <br />Dysart Environmental, Inc. Tel. (650 799-9204 <br />FLAP # 2764 Web: DysertEnvironmental.com <br />ON <br />041951: Chain of Custody <br />Page 1 of 2 <br />MW 8of19 <br />w ACCt-.1TEST• <br />C41951 " U-1.1— <br />