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WAT <br />' �� Mblb lwYy LLG <br />Client/Company Name: BobGoodmark <br />Address: 3217 Lombard Ave, Everett, WA, 98201 <br />Office Phone #: <br />Project Manager: Bob Goodmark <br />Project Manager Phone #: (713) 385-7548 <br />CHAIN OF CUSTODY <br />Project Name: TEMPLE BETH OR, Parcel #00439076300900, Survey <br />Project/PO Number: <br />Project Address:3217 Lombard Ave, Everett, WA, 98201 <br />Email: rlgoodmarkl@att.net <br />Batch #: WATK2304035 <br />Job use only <br />Asbestos <br />Lead <br />Mold <br />Sample Condition <br />x <br />PLM Bulk Asbestos <br />Paint Chip <br />Bulk <br />Good <br />PLM Tape Lift <br />Swab <br />Tape Lift <br />Damaged <br />PLM 400 Point Count <br />Air <br />Air <br />Severe Damage <br />PLM 1000 Point Count <br />note: separoteform required/or <br />lead and mold air somples <br />Turnaround Time: <br />Number of Samples: 69 <br />SEQ# <br />Sample ID/Location <br />Sample Description <br />SEQ# <br />Sample ID/Location <br />Sample Description <br />51 <br />22-2 Bath <br />Shower Surround Caulk <br />76 <br />52 <br />23-1 Bath <br />Baseboard Mastic <br />77 <br />53 <br />23-2 Bath <br />Baseboard Mastic <br />78 <br />54 <br />Pb-1 Exterior <br />Gray Paint Chip <br />79 <br />55 <br />Pb-2 Exterior <br />Green Interior Siding Paint <br />80 <br />56 <br />Pb-3 Exterior <br />Gray Trim Paint <br />81 <br />57 <br />Pb-4 Rear Deck <br />Red Paint Chip <br />82 <br />58 <br />Pb-5 Rear Deck <br />Dark Gray Paint Chip <br />83 <br />59 <br />Pb-6 Exterior Shed <br />Yellow Paint Chip <br />84 <br />60 <br />Pb-7 Exterior Shed <br />Brown Paint Chip <br />85 <br />61 <br />Pb-8 Exterior Shed <br />Torquise Paint Chip <br />86 <br />62 <br />Pb-9 Basement <br />Blue Paint Chip <br />87 <br />63 <br />Pb-10 Basement <br />White Paint Chip <br />88 <br />64 <br />Pb-11 Basement <br />Gray Paint Chip <br />89 <br />65 <br />Pb-12 Basement Stairs <br />Green Paint Chip <br />90 <br />66 <br />Pb-13 Basement <br />Yellow Paint Chip <br />91 <br />67 <br />Pb-14 Hall <br />Beige Paint Chip <br />92 <br />68 <br />Pb-15 Hall <br />White Paint Chip <br />93 <br />69 <br />Pb-16 Bath <br />Purple Paint Chip <br />94 <br />70 <br />95 <br />71 <br />96 <br />72 <br />97 <br />73 1 <br />98 <br />74 1 <br />99 <br />75 1 <br />100 <br />Print Name <br />Signature <br />Company Name <br />Date <br />Time <br />Sampled <br />Cooper Belisle <br />;1 <br />WAT <br />6/2/2023 <br />10:30am <br />Relinquished <br />Cooper Belisle <br />WAT <br />6/2/2023 <br />10:30am <br />Delivered <br />Cooper Belisle <br />WAT <br />6/2/2023 <br />1:00pm <br />Received <br />Cooper Belisle <br />GA <br />WAT <br />6/2/2023 <br />1:OOpm <br />Analyzed <br />Cooper Belisle <br />WAT <br />6/5/2023 <br />8:15am <br />Reported <br />Cooper Belisle <br />OYP <br />WAT <br />6/5/2023 <br />11:10am <br />r <br />How would you like to be notified? Email x Phone <br />Washington Asbestos Testing LLC guarantees the test results provided are of a precision normal with the type of methods recognized in asbestos analysis. Washington Asbestos Testing <br />LLC accepts no legal responsibility for the purpose for which the client uses the test results. By signing this Chain of Custody form the client agrees to relieve Washington Asbestos Testing <br />LLC of any and all liability that may arise from the test results. <br />117nn Kii,kland Wnv C- azinA vi,ki nd .,A a4rl2a . taact G[C-va ca <br />Page 26 of 39 <br />