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CHAIN OF CUSTODY RECORD <br />209-858-6427 Jacob Staley <br />J.R. Simplot Company <br />P.O. Box 198 <br />Lathrop, CA 95330 <br />209-858-2511 <br />SEND RESULTS TO ALL PARTIES LISTED BELOW: <br />Jacob.Staley@Simplot.com <br />Project ID NA Project 23.5 P Tank <br />Name: <br />Remarks: <br />COLLECTED BY: Brennan White <br />SPECIAL <br />INSTRUCTIONS: <br />ANALYSIS <br />REQUESTED <br />( ) CAM 17- TTLC <br />(XX) 8 Metal TCLP <br />( ) STLC 10X Only <br />( ) Other, Note above in Special Instructions Section <br />TURNAROUND !48 Hours <br />TIME <br />Sample ID Lab ID <br />, t <br />Collection <br />Date <br />Matrix Notes or Sample Map, Etc. <br />23.5P Tank ComposilUil 6-.2.. <br />.„ <br />02/10/2021 Soil/Gravel <br />.! -• '.. <br />7 c, ' \ ( 7C( -..._ tkiNd N.,-- -.,, <br />1 <br />Relinquished By: <br />__ & Time t /,05.-po,.) <br />Received By: <br />LA........- &Time <br />) <br />Relinquished By: Date <br />& Time <br />Received By: Date <br />& Time ' 70 <br />Enviro-Chem, Inc. Laboratories <br />1214 E. Lexington Avenue <br />Pomona, CA 91766 <br />Ph: 909-590-5905 <br />Fax: 909-590-5907 <br />CA-DHS ELAP Certificate #1555 <br />Send Sample To.