DEQ-CFW_00059610

TescAmerica Denver Test�merica
4955 Yarrow Street Chain of Custody Record
Arvada, CO 80002
Phone [phone] Fax [phone]
Client Information
Sampler:
Lab PM.
Johnston, Michelle
Carrier Tracking No(s):
COC No:
Client Contact:
Mr. Michael Aucoin
Phone:
E-Mail:
[e-mail]
Page:
Page of
Company:
The Chemours Company FC, LLC
Analysis Requested
Job #:
Address:
c/o AECOM 4051 Ogletown Road, Suite 300
Due Date Requested:
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Preservation Codes:
A - HCL M - Hexane
B - NaOH N - None
C- ZnAcetate 0-Asl
D - Nitric Acid P - Na204S
E - NaHSO4 O - Na2SO3
F - McOH R - Na2S2SO3
G - Amchlor S - H2SO4
H - Ascorbic Acid T - TSP Dodecahydrate
I - Ice U - Acetone
J - DI Water V - MCAA
K - EDTA W - ph 4-5
L -EDA z - other (specify)
other:
City.
Newark
TAT Requested (days):
10 Business Days
State, Zip:
DE, 19713
Phone:
302.781.5873
PO #:
LBIO-67048/84202000-2231 QS1000
Email:
[e-mail]
WO #:
Project Name:
FAY-NC-DWR HFPO-DA Sampling
Project #:
28016914
Site:
SSOW#:
Sam le Identification
Sample Date
Sample
Time
Sample
Type
(C=comp,
G= rab)
Matrix
(W=..'t '
s=sora,
o_w,,wo;,,
eT=Tl ue,A=Air
Special Instructions/Note:
Preservation Code:
XXN
Possible Hazard Identification
= Non -Hazard = Flammable Skin Irritant Poison B Unknown Radiological
Sample Disposal (A fee may be assessed if samples are retained longer than 1 month)
= Return To Client = Disposal By Lab Archive For Months
Deliverable Requested: I, II, III, IV, Other (specify) Level IV
Special Instructions/QC Requirements:
Empty Kit Relinquished by: "
Date:
Time:
Method of shipment:
Relinquished by:
Date/Time:
Company
Received by:
Date/Time:
Company
Relinquished by:
Date/Time:
Company
Received by:
Date/Time:
Company
Relinquished by:
Date/Time:
Company P
Received by:
DatelTime:
Company
Custody Seals Intact:
Yes 1 No
Custody Seal No.:
Cooler Temperatures)'C and Other Remarks.

TestAmerica Denver
4955 Farrow Street
Arvada, CO 80002
Phone [phone]'.00 Fax [phone]
Chain of Custody Record
TestArYledca
Client Information
Sampler:
Lab PM:
Johnston. Michelle
Carrier Tracking No(s):
COC No:
Client Contact: Phone: E-Mail:
Mr. Michael Aucoin [e-mail]
Company:
The Chemours Company FC. LLC Analysis Requested
Page:
Page of
Job it:
Address:
c/o AECOM 4051 Ogletown Road, Suite 300
Due Date Requested:
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Preservation Codes:
A - HCL M - Hexane3 - NaOH N - None
C - Zn Acetate O - AsNa02
D - Nitric Acid P - Na204S
E - NaHSO4 O - Na2SO3
F - McOH R - Na2S2SO3
H - A corbic Acid T- TSP Dodecahydrate
I - Ice U - Acetone
J - DI Water V - MCAA
K - EDTA W - ph 4-5
L -EDA Z- other(specify)
Other:
City:
Newark
TAT Requested (days):
10 Business Days
State, Zip:
DE, 19713
Phone:
81.5873
PO #:
LBIO-67048/84202000-2231 QS1000
,Email:
[e-mail]
WO #.
Project Name:
FAY-NC-DWR HFPO-DA Sampling
Project #:
28016914
Site:
SSOW#:
Sample Identification
Sample Date
Sample
Time
Sample
Type
(C=comp,
G= rab
Matrix
(W=w to
s=—lid.
c=w, "1.1"
BT=Till- A=Air
Special Instructions/Note:
Preservation Code:
><X
N
Possible Hazard Identification
= Non -Hazard = Flammable Skin Irritant Poison B Unknown Radiological
Sample Disposal (A fee may be assessed if samples are retained longer than 1 month)
= Return To Client 0 Disposal By Lab Archive For Months
Deliverable Requested: I, II, III, IV, Other (specify) Level IV
Special Instructions/QC Requirements:
Empty Kit Relinquished by: 7- -' _
Date:
Time:
Method of shipment:
Relinquished by:
Date/Time:
Company Received by:
Date/Time:
Company
Relinquished by:
DatefTime:
Company Received by.
Date/Time:
Company
Relinquished by:
Date./Thine :
Company Received by:
DaleFrime:
Company
Custody Seals Intact:
\ Yes \ No
Custody Seal No.: Cooler Temperature(s) "C and Other Remarks:

TestAmerica Denver TestAmerica
4955 rvada, Yarrow 8000Street Chain of CustodyRecord
Arvada, CO 80002
Phone [phone] Fax [phone]
1 n1FR IN F'4VIR0NMF.NTAv_ T'
Client Information
Sampler:
Lab PM:
Johnston, Michelle
Carrier Tracking No(s):
COC No:
Client Contact:
Mr. Michael Aucoin
Phone
E-Mail:
[e-mail]
Page:
Page of
Company:
The Chemours Company FC, LLC
Analysis Requested
Job #:
Address:
c/o AECOM 4051 Ogletown Road, Suite 300
Due Date Requested:
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Preservation Codes:
A - HCL M - Hexane
B - NaOH N - None
C -Zn Acetate 0-AsNa02
D - Nitric Acid P - Na204S
E - NaHSO4 Q - Na2SO3
F - McOH R - Na2S2SO3
G - Amchlor S - H2SO4
H - Ascorbic Acid T - TSP Dodecahydrate
I - Ice U - Acetone
J- DI Water V- MCAA
K - EDTA W - ph 4-5
L - EDA Z - other (specify)
Other:
City:
Newark
TAT Requested (days):
10 Business Days
State, Zip:
DE, 19713
Phone:
302.781.5873
PO #:
LBIO-67048/84202000-2231 QS1000
Email:
[e-mail]
WO #:
Project Name:
FAY-NC-DWR HFPIJ-DA Sampling
Project #:
28016914
Site:
SSOW#:
Sample Identification
Sample Date
Sample
Time
Sample
Type
(C=comp,
G= rab
Matrix
(w=w tor.
s=5oim.
o=__"1ou.
aT=Tss�e,A=Air
Special Instructions/Note:
Preservation Code:
XXN
Possible Hazard Identification
Non -Hazard 1=1 Flammable Skin Irritant Poison B Unknown Radiological
Sample Disposal (A fee may be assessed if samples are retained longer than 1 month)
Return To Client Disposal By Lab Archive For Months
Deliverable Requested: I, II, III. IV, Other (specify) Level IV
Special Instructions/QC Requirements:
Empty Kit Relinquished by:
Date:
Time:
Method of shipment:
Relinquished by:
Date/Time:
Company
Received by:
Datelrime:
Company
Relinquished by:
DatelTime:
Company
Received by:
Date/Time:
Company
Relinquished by:
Date/Time:
Company
Received by:
bate/Time:
Company
Custody Seals Intact:
\ Yes :\ No
Custody Seal No.:
Cooler Temperature(s) °C and Other Remarks:

' Tes4America Denver Test�meriea
4955 Yarrow Street Chain of CustodyRecord
Arvada, CO 80002
Phone [phone] Fax [phone]
"lit I FADER IN EWRONMFNTAL TFSTrNG
Client Information
Sampler:
Lab PM:
Johnston, Michelle
Carrier Tracking No(s):
COC No:
Client Contact:
Mr. Michael Aucoin
Phone:
E-Mail:
[e-mail]
Page:
Page of
Company:
The Chemours Company FC, LLC
Analysis Requested
Job #:
Address:
c/o AECOM 4051 Ogletown Road, Suite 300
Due Date Requested:
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Preservation Codes:
A - HCL M -Hexane
B - NaOH N - None
C -Zn Acetate O - AsNa02
D - Nitric Acid P - Na204S
E-NaHSO4 0-Na2SO3
F - McOH R - Na2S2SO3
0 - AS - H2SO4
H - Ass c corrbicbic Acid T - TSP Dodecahydrate
I - Ice U - Acetone
- DI Water V - MCAA
K - EDTA W - ph 4-5
L -EDA Z- other(specify)
Other:
City:
Newark
TAT Requested (days):
10 Business Days
State, Zip:
DE,19713
Phone:
302.781.5873
PO #:
LBIO-67048/84202000-2231 QS1000
Email:
[e-mail]
W O #:
Project Name:
FAY-NC-DWR HFPO-DA Sampling
Project #:
28016914
Site:
SSOW#:
Sample Identification
Sample Date
Sample
Time
Sample
Type
(C=comp,
G= rab
Matrix
(w=w,m..
S=solitl,
o=w"'telofl,
BT=Tis 'A=Air
Special Instructions/Note:
Preservation Code:
>IN
N
Possible Hazard Identification
= Non -Hazard 1=1 Flammable Skin Irritant Poison B Unknown Radiological
Sample Disposal (A fee may be assessed if samples are retained longer than 1 month)
= Return To Client = Disposal By Lab Archive For Months
Deliverable Requested: I, II, III, IV, Other (specify) Level IV
Special Instructions/QC Requirements:
Empty Kit Relinquished by: 17 .,
Date:
Time:
Method of shipment:
Relinquished by:
Date/rime:
Company
Received by:
Date/Time:
Company
Relinquished by:
Date/rime:
Company
Received by:
Date/Time:
Company
Relinquished by:
Date/rime:
Company
Received by:
Date/Time:
Company
Custody Seals Intact:
d Yes A No
Custody Seal No.:
Cooler Temperature(s)'C and Other Remarks:

_ TestAmerica Denver
4955 Yarrow Street
Arvada, CO 80002'
Phone [phone] Fax [phone]
Chain of Custody Record
TestAmedca
-11- ! rAOFS M FNv1o0MNFNT0k4
Client Information
Sampler:
Lab PM:
Carrier Tracking No(s):
COC No:
Johnston, Michelle
Client Contact: Phone: E-Mail:
Page:
Mr. Michael Aucoin [e-mail]
Page of
Company:
The Chemours Company FC, LLC Analysis Requested
Job #:
Address.
Due Date Requested:
c/o AECOM 4051 Cgletown Road, Suite 300
Preservation Codes:
A HCLNaO
City:
TAT Requested (days):
Newark
10 Business Days
- N - None
C- ZnAcetate 0-AsNa02
State, Zip:
DE, 19713
D - Nitric Acid P - Na204S
E - NaHSO4 0 - Na2SO3
F - McOH R - Na2S2SO3
Phone:
PO #:
302.781.5873
LB IO-67048/84202000-2231 QS 1000
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G - Amchlor S - H2SO4
H - Ascorbic Acid T - TSP Dodecahydrate
Email:
WO #:
[e-mail]
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0
I- Ice U- Acetone
w
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J - DI Water V - MCAA
K - EDTA W - ph 4-5
Project Name:
Project #:
FAY-NC-DWR HFPO-DA Sampling
28016914
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L -EDA Z- other(specify)
Other:
Site:
SSOW#:
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Sample
Matrix
0
Type
(vii - ,
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Sample
(C=comp,
S=solid,
o=wasm/oa,
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Sample Identification
Sample Date
Time
G= rab)
BT=Tiss ,A=Air)
u
I If
I i
Special Instructions/Note:
Preservation Code:
N
3,
Possible Hazard Identification
Sample Disposal (A fee may be assessed if samples are retained longer than 1 month)
0 Non -Hazard = Flammable Skin Irritant Poison B Unknown Radiological
0 Return To Client 0 Disposal By Lab Archive For Months
Deliverable Requested: I, II, III, IV, Other (specify) Level IV
Special Instructions/QC Requirements:
Empty Kit Relinquished by: , _
Date:
Time:
Method of Shipment:
Relinquished by:
Date/Time:
Company
Received by:
Date/Time:
Company
Relinquished by:
Date/Time:
Company
Received by:
Date/Time:
Company
Relinquished by:
Date/Time:
Company
Received by:
Date/Time:
Company
Custody Seals Intact:
Custody Seal No.:
Cooler Temperature(s) "C and Other Remarks:
n Yes 4 No

• Tes"t -America Denver
4955 Yarrow Street
Arvada, CO 80002
Phone [phone] Fax [phone]
Chain of Custody Record
TestAmerica
-. ' n,!1[R IM FNV1Al'YIVMF�!TA! _,
Client Information
Sampler:
Lab PM:
Johnston, Michelle
Carrier Tracking No(s):
COC No:
Client Contact: Phone: E-Mail:
Mr. Michael Aucoin [e-mail]
Company:
The Chemours Company FC, LLC Analysis Requested
Page:
Page of
Job #:
Address:
c/o AECOM 4051 Ogletown Road, Suite 300
Due Date Requested:
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Preservation Codes:
A -HCL M-HexaneB - NaOH N -None
C -Zn Acetate 0-AsNa02
D - Nitric Acid P - Na204S
E-NaHSO4 Q-Na2SO3
F - McOH R - Na2S2SO3
H - Ascorbic Acid T - SP Dodecahydrate
I - Ice U - Acetone
J - DI Water V - MCAA
K - EDTA W - ph 4-5
L-EDA Z- other(specify)
Other:
City:
Newark
TAT Requested (days):
10 BUSIneSS Days
State, Zip:
DE,19713
Phone:
781.5873
PO #:
LBIO-67048/84202000-2231 QS1000
Email
[e-mail]
WO #:
Project Name:
FAY-NC-DWR HFPD-DA Sampling
Project #:
28016914
Site:
SSOW#:
Sample Identification
Sample Date
Sample
Time
Sample
Type
(C=comp,
G= rab
Matrix
(w=war
S=solid,
o=wasc�ma,
BT=Tis ,A=Air
Special Instructions/Note:
Preservation Code:
N
ix
Possible Hazard Identification
0 Non -Hazard 0 Flammable Skin Irritant Poison B Unknown Radiological
Sample Disposal (A fee may be assessed if samples are retained longer than 1 month)
= Return To Client = Disposal By Lab Archive For Months
Deliverable Requested: I, Il, III, IV, Other (specify) Level IV
Special Instructions/QC Requirements:
Empty Kit Relinquished by: w% _
Date:
Time:
Method of shipment:
Relinquished by:
Daternme:
Company
Received by:
Date/Time:
Company
Relinquished by:
Daterrime:
Company
Received by:
Date/Time:
Company
Relinquished by:
Date/Time:
Company
Received by:
Date/Time:
Company
Custody Seals Intact:
N Yes N No
Custody Seal No.:
Cooler Temperature(s)'C and Other Remarks:

TestAmerica Denver
4955 Yarrow Street
Arvada, CO 80002 Chain of CustodyRecord TestAmedco
Arvada,
Phone [phone] Fax [phone] T++F + FApF� w -r --
Client Information
Sampler:
Lab PM:
Johnston, Michelle
Carrier Tracking No(s):
COC No:
Client Contact: Phone: E-Mail:
Mr. Michael Aucoin [e-mail]
Company:
The Chemours Company FC, LLC Analysis Requested
Page:
Page of
Job #:
Address:
c/o AECOM 4051 Ogletown Road, Suite 300
Due Date Requested:
_
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Preservation Codes:
A-HCL M-Hexane
B - NaOH N - None
C -zn Acetate O-oNaoz
D - Nitric Acid P - Na204S
E-NaHSO4 Q-Na2SO3
F - McOH R - Na2S2SO3
G - Amchlor S - H2SO4
H -Ascorbic Acid T - TSP Dodecahydrate
I -Ice U -Acetone
J - DI Water V - MCAA
K - EDTA W - ph 4-5
L -EDA Z- other(specify)
Other:
City:
Newark
TAT Requested (days):
10 Business Days
State, Zip:
DE,19713
Phone:
302.781.5873
PO #:
LBIO-67048/84202000-2231 QS1000
Email:
[e-mail]
WO #:
Project Name:
FAY-NC-DWR HFPO-DA Sampling
Project #:
28016914
Site:
SSOW#:
Sample Identification
Sample Date
Sample
Time
Sample
Type
(C=comp,
G= rab)
Matrix
(W=.v,+.r.
S=solid.
o=w,,mroa,
,A=Air)
Special Instructions/Note:
Preservation Code:
N
Possible Hazard Identification
= Non -Hazard 1= Flammable Skin Irritant Poison B Unknown Radiological
Sample Disposal (A fee may be assessed if samples are retained longer than 1 month)
= Return To Client = Disposal By Lab Archive For Months
Deliverable Requested: I, II. III. IV, Other (specify) Level IV
Special Instructions/QC Requirements:
Empty Kit Relinquished by: _
Date:
Time:
Method of shipment:
Relinquished by:
Date/Time:
i�
Company
Received by:
DaterTime:
Company
Relinquished by:
Daterrime:
Company
Received by:
DatefTime:
Company
Relinquished by:
Daterrime:
Company
Received by.
Daterrime:
Company
Custody Seals Intact:
1 Yes A No
Custody Seal No.:
Cooler Temperature(s) °C and Other Remarks: