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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 />Dysert Environmental, Inc. <br />City, State & Zip <br />San Mateo, CA 94402 <br />P.O. No. <br />P.O. Box 5608 <br />Laboratory <br />ANC C 4k 00SID <br />Samplerls <br />` _ <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 />Pactiv, Jeff <br />Sample Matrix = <br />Wastewater <br />Field Notes: <br />Q <br />J <br />�(L <br />8 LL <br />N <br />ro <br />�' <br />U LL <br />N <br />Vl m <br />PL <br />Turn Around <br />Time = 5 DayNo. <br />Sample ID: <br />of <br />Date: Time:Containers <br />1z. M.L HNO] <br />7 x 40mL VOA HCL <br />2x 7L ABR GL NP <br />X <br />X <br />c/Xa. <br />Rellnq .d ¢ 1 } �—� R -1-d by <br />Additional Mailing Instructions: <br />CC: <br />R.I n i A I fjjte by Tim <br />'�G, — <br />R.b qulsh.d by R ... H.d by 1 Tim. <br />; O . �G <br />Relinqulshed by Recelr.d by Tho. <br />0.1. <br />Lab Notes: Notes: <br />Sample Temperature Upon Recei t in Lab = e <br />Page 1 of 1 <br />Dysert Environmental, Inc. Tel: (650) 799-9204 <br />ELAP # 2764 Web: DysertEnvironmentaLcom <br />My <br />C4195OW: Chain of Custody <br />Page 1 of 2 <br />IMM 8of14 <br />N ACCLITEST. <br />C4195OW ""°""'u" I .. <br />