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TestArnerlca Pleasanton Test�41'Ylel1ea <br /> 1220 Quarry lane Chain of Custody Record <br /> Pleasanton, CA 94566 TNF LFADFF IN FNWQInNIVFN7AA TFSTINr: <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM C T,rp�ric(>!) .a/ COC No, <br /> Client information {Sub Contract Lab) Smith,Micah (Ir/ G -fid/ 720-38065-3 <br /> Client Contact Phone E-Mark State of Origin Page: <br /> ShippinglReceiving micah.smith@teatamericalnc.com California Page 3 of 4 <br /> Company Accre Mations Required(See note). Job# <br /> TestAmerica Laboratories,Inc NELAP-California;State Program-California 720-85751-1 <br /> Address Due Date Requested: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 4118/2018 Analysis Requested A-HCL M-Hexane <br /> City TAT Requested(days): y, B-NsOH N-None <br /> Irvine m C,Zn Acetate O-AsNa02 <br /> State,Zip c D-Nitric Acid P-Na204S <br /> CA,92614-5817 $ NaHSo4 0-Na25o3 <br /> Phone PO# £ F.MCOH R-Na2S203 <br /> G-Amchtof S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) o v H-Ascorbic Acid T-TSP Oodecahorate <br /> Email WO# $, 1•Ice U-Acetone <br /> o J-DI Water V•MCAA <br /> ';$' K-EDTA W•pH 4-5 <br /> Project Name Project# = L-EDA Z-other(s)eody) <br /> Nestle-Ripon 72000256 c <br /> Site SSONf# o Other: <br /> Sample Matrix <br /> Type Iw...mr. <br /> Sample (C=Comp, <br /> Sam le Identification-Cftrit ID Lab ID Sample Date Time G= roSacral]nstrt>etionslNote: <br /> Prett(dri'Cd33:' <br /> M-35A(720-85751-23) 415118 1126 Water X 3 <br /> v P tfIG <br /> QM-358(720-85751-24) 415118 P F3_2 Water Xacifi3 <br /> OD M-358 DUP(720-85751-25) 415!18 11-32 Water X 3 <br /> Pacific <br /> M-35D(720-85751-26) 415118 11'40 Water X 3 <br /> Pacific <br /> M-528(720-85751-27) 415118 15.37 Water X 3 <br /> P cifc <br /> M-53B(720-85751.28) 4!5118 15-43 Water X 3 <br /> Pacific <br /> M-813(720-B5751-29) 415118 P if c Water X 3 <br /> M-8131(720-85751-30) 415118 1611 Water X 3 <br /> Pacific <br /> MID(720-85751-31) 4!5118 16-22 Water X 3' <br /> P cific <br /> Note Since laboratory accruditations are subject to change,Tesl[Amence Laboratories.Inc places the ownership of method.analyte&accreditation compliance upon out subcontract laboratories This sample shipment is forwarded under chain-of-custody t <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer then 1 month) <br /> Unconfirmed I =Return TO Client ©Di4-%-V By Lab Archive For Months <br /> Deliverable Requested 1,ll,Ill,IV,Other{specify) Primary Deliverable Rank-2 Special InstructionsIM Requirements: <br /> Empty Kit Relinquished by: Date Time. Method of shipment <br /> Rshogwshed by Dat ime Co any Received by Daterrlme Company <br /> Relinquished by pate ime Company Received byOatefTlme Company <br /> ORelinquished by Daterrinie Company Received by D w e/8 09( Company /R—CD v <br /> CU y ais Intact: Custody Seal No.: Cooler Temperatures d Other Remarks <br /> A Yes Na fa <br /> 00 V ur.0912012016 <br /> n <br />