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TestAmLane Pleasanton Chain of Custody Record IIIYIII Y�VIVI�YYYYVI�Y IIYYYVY Test�tmeriea <br /> 1220 Quarry Lane <br /> Pleasanton, CA94566 <br /> 'ill:I.[Anri iN(4VIRnNNI'Nla1 tLCl�r.li <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler. Lab PM: CarrixT 72p-31:030.1 <br /> Client Information (Sub Contract Lab) Duong,Paloma R OM <br /> client Contact, Phone: E.M.lt: Isle wcagin: Page: <br /> ShippinglReceiving paloma.duong@testamencainc.com Califomia Page 1 of 1 <br /> Company., Acendudons Requind(See ride): Job%: <br /> Test. <br /> merica Laboratories,Inc NELAP-California;State Program-Califomia 720-75507.1 <br /> Address: - Oue Date Ral]uwtM: Preservation Codes; <br /> 17461 Dadan'Ave, Suite 100, 11/3/2016 Analysis Requested A-HCL M-Hadna <br /> CIM TAT Requuled(daya): 0-Neon N-None <br /> Irvine c-Zn Acetate 0-AsNe02 <br /> ,Zip: D-NIInc Add P-M204S <br /> State, <br /> Zip: H77 E-NaHSO4 O-Na2S03 <br /> F-MeOH R-Na2S203 <br /> Phoria: PO%: <br /> G-AmcMor S-H2SO4 <br /> Ermain 1.1022(Tel) 949-260J297(Faz) `o I-Ic. do Add T-TSelorwa anydrale <br /> Finall: WO#: = -Ice V-ACetmte <br /> K-5Water V-MOM <br /> K-EDTA W-pH4d <br /> McDo Name: Pq.c72009: 'g` L-EDA Z-other(seedy) <br /> McDondald Island Production Tank,McDond 72009842 <br /> Site: _ $SOW%: E .� Oeler. <br /> o `8 <br /> Semple Matrix �L E i r.9 <br /> Type <br /> Sample (C=dmhp, <br /> -0 Sam le Identification-Client ID Lab ID Sample Date Time G- rab m•mw,A-a4 r. c in. S clal InstructionsMote: <br /> m Preservetlon Code:. <br /> 15:10 <br /> N WHISKEY SLOUGH-TANK#C-6(720-75507-1) 10/28/16 P .fi Water X X 4' <br /> Co <br /> 0 <br /> Co <br /> Co <br /> Note Since Mboratory secreEltations ere subjad to Change,TestAmeda tabocalmles,Inc.daces he cemalship of medial,anayte E acmaditadcn compliance upon cut subconead laboratories.This sample shipmentle forwarded under chalnQ<ustotly. If the laboratory does not <br /> cuma dy maintain accrecIfid.In the Stale pf Origin lasted above far enslyslskestslmaeN ban,analysed,me samples must be shipped back to the Ted"ada laboratory,m other insucclions will be pmvidee.Any changes to accredltatlon status slictid be brpe,htts TaftAmerica <br /> Labmtodas.me.fientim immedlelely. If all requested accredflalbns are currant to date.Mum me signed chain of custody attesting to sold campgcance to TeslAmeda Labmalolles,Inc. <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed 1 1:1 Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I,11,III,N,Other(specify) Primary Deliverable Rank:2 Special Instructions=Requirements: <br /> Empty Kit Relinquished by: Date: Time: Meinod of Shipment: <br /> Relinquished by. DataTl t,-, Compe Recdved by. DataRime: Company <br /> D erS.V-t <br /> Rmirgdsmdby. Da Ime: Company Received by. Damrima: Company <br /> N <br /> O Ramqulshed br. DelaRime: company ce r by. Oate1T1 Company <br /> W <br /> Custody Seals Intact lCustody Seal No.: Coder eralure(a)°C and mar Remarks: 17 o GC _�`r <br /> 'A Yes' a No G <br />