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TestAmeriPleasanton TestA 1 le ica <br /> Plea Quarry Lane <br /> Chain of Custody Record <br /> Pleasanton, CA 94566 TVF LCADFR IN TNVIPONMFNTAi TFSTING <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM [Camer T a No(s) COC No <br /> Client Information (Sub Contract Lab) Smith,Micah 3L� ;_7Z jgC1_9W/ 720-38065.4 <br /> Client Contact Phone E-Mad State of ONgrn Page- <br /> ShlppmglReoeiving micah.smith@testamenca€nc.com California Page 4 of 4 <br /> Company Accredtahons 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 140, 4/1812018 Analysis Requested <br /> [A-HCL M-Hexane <br /> City TAT Requested{days): B-NaOH N-Nene <br /> Irvine a C.Zn Acetate 0-AsNa02 <br /> State,Zip' c D-Mine Acid P-Na204S <br /> CA,92614-5817 n E-NaHSO4 0-Na2So3 <br /> Phone PO# 6 F-McOH R-Na2S203 <br /> v G-Amchlor 5-H2504 <br /> 949261-1D22(Tel) 949-2$0-3297(Fax) v H-Ascorbic Acid T-TSPDodecahydrate <br /> Email WO# !-ice U-Acetone <br /> J-DI Water V-MCAA <br /> Protect Name Protect# <br /> ".• K-EDTA W-pH 4-5 <br /> Nestle-Ripon 720D0256 <br /> = L-EDA Z-other(specify) <br /> Site SSOW# i• Other: <br /> m V <br /> Sample Matrix <br /> Tye (wwaoar, 3I Zi <br /> S=solid, <br /> Sample (C=camp, <br /> Sam le Identification-Client ID Lab ID Sam Ie Date Time G= rab) eT-ri.>,w,A=Ai m m i Special Ins <br /> tractionslNote: <br /> Prs6twation,Go�e' <br /> � ' <br /> E-2(724-85751-32) 415/18 16;30 Water X 3' <br /> Pacific <br /> 00 E-6(724-85751-33) 415118 16:38 Water X 3 <br /> 0 Pacific <br /> Note Since laboratory accreditatlons are subject to change,TeslAmenca Laboratories,Inc places the ownamhrp of method,analyte 8 accreditation compliance upon out subcontract laboratones This sample shipment is forwarded under Cham-0f-custody I <br /> Possible Hazard ldenfihcation Sample Disposal(A fee may be assessed if samples are retained longer than'I month) <br /> Unconfirmed ©Return To Client ©Disposal By Lab Archive For Months <br /> Defrverabre Requested'i,II,Ill,IV,Other(specify) Primary Deliverable Rank.2 Special InstructionsfQC Requirements' <br /> Empty Kit Relinquished by' Date- Time- Method of Shipment <br /> Relinquished by DatelTl e. Co a Received by Dete(Tma Company <br /> t��- r6o <br /> Retinquished by DatelTime Co pan Received by DatelTime Company <br /> N <br /> Relinquished by DatelTime Company Received by DatefTl St n Dom. 1� Compapyy,._ rp t t <br /> O j } r XV Lr�t_CL 7.1Lf1 ( t! <br /> N <br /> O LEPI, <br /> Intact, Custody Seal No.: CoolerTemperatur ter Remarks !12-5! ! 3 0 <br /> 00 No �i t// <br /> V :U9!„0/201h <br />