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CHAIN OF CUSTODY/ANALYSIS REQUEST <br /> Attention----- Mark Dysart Phone-- - (650)799-9204 - milling(if different- -- <br /> Company Name Dysert Environmental, Inc. Email environmental.data@gmail.com Attn:Accounts Payable <br /> Mailing Address P.O. Box 5608 Mobile Dysert Environmental,Inc. <br /> City,State&Zip San Mateo,CA 94402 P.O.No. P.O.Box 5608 <br /> Laboratory ANCC 4k SID Samplerts ` _ San Mateo,CA 94402 <br /> Pactiv Packaging, Inc. Pactiv Packaging, Inc. sampling Code= <br /> Project Project <br /> Name 4545 Qantas Lane Location 4545 Qantas Lane Pactiv,Jeff <br /> Stockton,CA 95206 Stockton,CA 95206 <br /> Sample Matrix= Field Notes: t : <br /> Wastewater -' J <br /> Turn Around a LL U LL I <br /> Time=5 Day L) °>N °cm <br /> J Co N 0* <br /> Sample ID: Date: Time: No.of k a a. <br /> Containers �/ �/w w <br /> 1 s 260mL PL NNO7 X X X <br /> x�OTL VOA NCL <br /> 2 z 1L ABR GL NP <br /> Rallnq ed¢ �,� Received by nn Tima ,la ,7 <br /> l � -•(L.l�ItiCJ_: __yE -)�- Additiolial Mailing instructions: <br /> Rein I vii, 1 Ij{_e� by Tlm© `J�, <br /> Rah qulshed by - Rocelvod by Tlmo ;~J O Da� G -CC: <br /> Z <br /> Rallnqulahadby R-1-d by Tlme DaU <br /> Lab Notes: Notes: <br /> Sample Temperature Upon Recel t in Lab= l <br /> Dysert Environmental, Inc. Tel.(650) 799-9204 <br /> ELAP#2764 Web:DysertEnvironmental.com Page 1 of 1 <br /> 041950: Chain of Custody <br /> Nage 1 of 2 <br /> INS 14 of 40 <br /> ■ACCtJTES-F <br /> C41950 L..e <br />