Laserfiche WebLink
San Francisco 'Jp Tester nerica <br /> Pjeasanton,CA 94566 n <br /> 1220 Quarry Lane it) <br /> ow <br /> V � Chain of Custody Record ;,,,.,EAar,,:,EN�R17,,:W N1 1,1 Tr_,,,nn <br /> phone 925 484.1919 fax 925.600.3002 TestArnerica Laboratories,Inc. <br /> Client Contact Project Manager: ! Site Contact: Date: COC No: I <br /> GHD Inc. �(�• Tel/Fax:949-929-9655 Lab Contact:Micah Smith Carrier: .fl —1 ofl— COCl <br /> (,os it0 u nary• (� Analysis Turnaround Time <br /> Job No. 11119016 <br /> Feesrto 3720 <br /> Lid',Ci q q ^(•s b 1'1 Calendar t C l of Work Dai s I W) _ <br /> X53 329 OQ Phone l7- 1 ^Z O j„J 1.v x(,101 nt I'—,ndh,,, a t <br /> �� 6 <br /> 559926 590^ FAX 2 necks SDG No <br /> V <br /> Project Name T LI _� �n ,Cr,-4) I week T .^ J1 A <br /> Site 1 ! C C.l f:rQn U.,Ip 0 2 days <br /> P O# i 4 l162 -'t 032 U f a - I day E ! S rJ Sampler:Dan Glaze <br /> s5 <br /> .+ <br /> Sample Sample Sample N of x Q — 4- <br /> Date <br /> l Sample Identification Date Time Typeen Matrix cant. is g g `-5 - p► I I Sample Specific Notc,: <br /> z4 f17-L <br /> t� tJ .^7�Z 112I f r <br /> I <br /> 720-90502 Chain of Custody <br /> Presen•ntion Uscd: 1=lee, 2=HCI; 3=H2SO4; 4=HNO3; 5=NnOH;6=Otbcr <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Nair-Ha=aril 0 Flannnuhle =Skin Invant P.n.anr R Unknown 0 0 Return To Client Disposal By Lab Archive For Months <br /> Special Instructions/IQC Requirements&Comments: pp A r <br /> � re its G1�Av ,M, p�c�vx^tztc �l^d tOm � <br /> 5.5 <br /> Rclinyuished y; Cumpan Dated imr. R civ b C'um any: p i <br /> 1 12 �t �!3 <br /> Rclinquishcd by: Company paten ime. Rece y Company. Date% me: <br /> Relinquished by: Compam' Datc/Time Received by Company: DatrrTimc: <br /> IV <br /> Form No.CA-C-WI-002,Rev.2,dated 03/06/2012 <br /> O_ <br />