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TestAmeriPleasanton Chain of Custody Record IIIIINN�IIIIAiIA�19N8��I�I I�N Test>r4meriea <br /> 1220 Quarry Lanane <br /> Pleasanton, CA 94566 <br /> 'l1E I.fAI[q IN fM•IGOMRI[.YiA. ][Y r.':4 <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> aemplen Lab PhtCard kl COC No: <br /> Client Information (Sub Contract Lab) Duong,Paloma R 2 720-31030.1 <br /> Clknl Cooled From: E-M. State a Odgln: Page: <br /> Shipping/Receiving paloma.duong@testamericeine.com California Page 1 of 1 <br /> Comppny. AcCrestaflons Requlmd(sea note): Job A: <br /> TesVNnedna Laboratories,Inc NELAP-California:State Program-California 720-75504-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 17461 Dorian Ave, Suite 100, 11/3/2016 Analysis Requested <br /> A-ML M-Hexane <br /> City TAT RegbutM(days): R- N-No <br /> Wine C-Zo Zn Ac ne <br /> Ac&ata 0-AsNa02 <br /> stale,7Jp: D-Niftdc Add P-Na2045 <br /> CA,92614.5817 E-NaHSO4 0-Ne2SO3 <br /> F-MeOH R-NQS203 <br /> Phone: POk <br /> G-Amchbr S-H2504 <br /> 949-261-J022(Tel) 949-260-3297(FaX) ^o -1.Ascorbic Antl -Tranyvrate <br /> I <br /> Email: WO a: Z -Ice D-Acelone <br /> AA <br /> rd C J-p Water V-MCM <br /> x K-EDTA W-pH4-5 <br /> PrcDonAma: Project A: 2 L-EDA z-odier(apedly) <br /> McDondeld Island Production Tank,McDond 72009842 � <br /> 5ae: ssow#: E other: <br /> Sample Matrix E <br /> Type <br /> sample (C=comp, a..e.ur.11, d x <br /> -O Sam Is Identification-Client ID Lab ID Sample Date Time Gs rob s.Ti--,A..w S r rc s eclat InatructlonalNote: <br /> .. , <br /> Preservation.Code.,, � . <br /> .. -:. .:. <br /> UZI <br /> (D 13:05 <br /> N WHISKEY SLOUGH-TANK#D-2(720-75504-1) 10/28/16 Water X X 4 <br /> O_ <br /> N <br /> J <br /> Note:Since IabbraeayaccmGlaeons aro subjecttochanpa,TesWn aLabomtaim,Inc pacestiro ownershipofmethod,analyst a accreditation wmetiance upon out submnbacllaboratories.ThissampleshipmentkforwardedunderchgMQiWtody. If Melaboratoryhoesnot <br /> curongy maintain arvedgatlbn In the Slab of Origin listed above to ansyslsnesl4maoixbeing analyred,the samples must be shipped tact,to the TesWnerics labondury a bear instuetions wt te prcNdad.Anychangestoacb ltatibnstaWsslwuldbehmaghtb Tose roa <br /> Laboratories,Inc,attention Immediately. If all requestetl accrea4atlons are mmwt to date,raWm he signed!Chain of Custody ouesag to said oomph encs m Tow"adce Labaatodes,Inc. <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed I =Return To Client =Disposal B Lab Archive For Months <br /> Deliverable Requested:I,It,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions=Requirements: <br /> Empt/Kit Relinquishe by: Date: Time: wthwof smlxnenc <br /> Relingblahad by. DalelR Company Reoev dlby. D.Unnme: Company <br /> ?r /0 3/ <br /> Relingbisad by. Dal me: Company Received by. DMamme: Company <br /> N <br /> RvinqulsaE by. Dala/nme: Company el Dy. Dal Co an <br /> 1 1 0 <br /> Custody Seals Intact Custody Seal No.: Coder raWre(s)°cera tar Remarks: pa <br /> A Yes e No 3,1oC_ 3uC <br />