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1- <br />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 />Q <br />P.O. Box 5608 <br />Laboratory <br />(,� v <br />ANCl�� <br />Sampler/s <br />lC( _ <br />San Mateo, CA 94402 <br />Project <br />Name <br />Pactiv Packaging, Inc. <br />4545 Qantas Lane <br />CA 95206 <br />Project <br />Location <br />Pactiv Packaging, Inc. <br />4545 Qantas Lane <br />Stockton, CA 95206 <br />Sampling Code= <br />Pactiv, JeffStockton, <br />Sample Matrix = <br />Wastewater <br />Field Notes: <br />a <br />U <br />Turn Around <br />Time = 5 Day <br />Sample ID: <br />Date: Time: No. of <br />Containers <br />I ibzOML PL lL PL PNDJ <br />V <br />Roll qula yR... 1,etl by Tlm <br />.(9 - Q- 0� <br />Dr <br />Additional Mailing Instructions: <br />C' <br />Re .IeI, �y tGIC V R.o_I�ggny TI <br />/� <br />"\ q•�—!✓Y'I <br />Ra uiabad by R ... ityatl by lime <br />LOr n D`a'l <br />�[ <br />Reliequ1'0] by Recaivetl by Tlma <br />Dela <br />Lab Notes: Notes: <br />` Please <br />Sample Temperature Upon Recei t In Lab = ' ' <br />hold addtl 1 PL NP <br />Page 1 of 1 <br />Dysert Environmental, Inc. Tel: (650) 799-9204 <br />ELAP It 2764 Web: DysedEnvironmentaLcom <br />041953: Chain of Custody <br />Page 1 of 2 <br />IN 8of19 <br />N AC(--U-FEST <br />C41953 L ... —.� —.,. <br />