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CHAIN OF CUSTODY/ANALYSIS REQUEST <br /> Attention Mark Dysert Phone (650)799-9204 Billing Of different) <br /> Company Name Dysert Environmental, Inc. Email environmental.data@gmail.com Attn:Accounts Payable <br /> Mailing Address P.O. Box 5608 Mobile Dysert Env/ronmental,Inc. <br /> City,State&Zip San Mateo,CA 94402 P.O.No. q t P.O.Box 5808 <br /> Laboratory ANC C (�� Samplerls (� V g� San Mateo,CA 94402 A <br /> Project Pactiv Packaging, Inc. project Pactiv Packaging, Inc. Sampling Code- <br /> Name 4545 Qantas Lane 4545 Qantas Lane Esta <br /> Stockton,CA 95206 Location Stockton,CA 95206 c�o8 6 <br /> Sample Matrix= Field Notes: <br /> WastewaterJ -J <br /> Turn Around y U. a' i <br /> Time=5 Day L,*—UV O C5 00 <br /> —\ N C4 <br /> Sample ID: Date: Time: No.oCo <br /> f a a <br /> lI Containers Lu w <br /> ' Qantas•Water Z� ) V 1 x 25001L PL HN07 X <br /> 7 x 40.L VOA HCL <br /> 2 x 1L ASR OL NP <br /> ftellnqu he qyy flecelved by ^. T1 ( ', <br /> Rel qu ryed�k4x ' ``�`j Additional Mailing Instructions: <br /> Oq Ivedby Tiny D <br /> © 2 t cc: <br /> Rel ul a by Ra<elved by Tlrty <br /> SIU Dete 47 S <br /> quleh<dby Rwelwd by Tlme Date <br /> Lab Notes: Notes: <br /> Off Site Contact:Craig Retzbach,Noble Environmental Services Corporation <br /> n M 10 Enterprise Drive,Carbondale,PA 18407 <br /> Sam le Tem erature Upon Receipt In Lab= �'�, '1 h,S'2-•-U,` S.f P.(570)282-5660,C.(570)510.0815 <br /> cretzbach@nobleenvironmental.com <br /> Dysert Environmental, Inc. Tel:(650) 799-9204 <br /> FLAP#2764 Web:DysertEnvironmental.com Page 1 of 1 <br /> C40869: Chain of Custody <br /> Page 1 of 2 <br /> MR 8 of 23 <br /> ■ACCLITESTe <br />