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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 Cit (\ J <br />Sampler/s <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 />SamplingCode= <br />Pactiv, Jeff <br />Sample Matrix = <br />Wastewater <br />Field Notes: <br />?v <br />a <br />U <br />Turn Around <br />Time = 5 Day <br />Sample ID: <br />Date: Time: No. of <br />Containers <br />S <br />[� 1 x 350mL PL HNO3 <br />-16 1x 1L PL NP <br />V <br />X <br />Relinquls �by T-R-1vedby Tlm <br />la <br />Additional Mailing Instructions: <br />c: <br />Reli isle (J 1 Racalvedb Timy <br />_ <br />Nnquiehed by Roceivsd by Timo <br />n o <br />�/ <br />Relinquisbedby Received by Tlmo <br />ealo <br />Lab Notes: Notes: <br />Please <br />Sample Tem eralure Upon Receipt in Lab = <br />hold addtl 1 L PL NP <br />Page 1 of 1 <br />Dysert Environmental, Inc. Tel: (650) 799-9204 <br />ELAP # 2764 Web: DysertEnvironmental.com <br />Z <br />01952: Chain of Custody <br />Page 1 of 2 <br />8of19 <br />■,o,ccu-rr=s-r <br />041952 <br />