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Tes <br /> 220 Quarry Lane Chain <br /> Pleasanton 111N� I I�I�qI N IN TestAmerica <br /> Pleasanton, CA 94566 Chain of Custody Record 1II II n I' <br /> THF LFAvrq iN,F4viQomwr14TA[ TI-STING <br /> phone(925)484-19'19 Fax(925)600-3002 <br /> Samples. Lab PM C r T k g s COC NO. <br /> client Information (Sub Contract Lab Smith,Micah ;J ' 'jr 720-37982.1 <br /> Client Contact- Phone E-Mail, State of Origin Page. <br /> Shipping/Receiving lmicah.smith@testamericainc,corn Callfomla Page 1 of 1 <br /> Company Accred€tations Required;Sea note)' Job#: <br /> TestAmerica Laboratories,Inc NELAP-California;State Program-California 720-85696-1 <br /> Address. Due Date Requestad: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 411612018 Analysis Requested A_HCL M-Hexane <br /> City TAT Requested(days): B-NaOHN-None <br /> Irvine C-Zn Acetate O-AsNa02 <br /> State,Zip D-Nitric Acid P-Na204S <br /> CA.92614 5817 E-NaHSO4 q-Na2S03 <br /> b E-hteOH R-rt82S203 <br /> Phone PO# y <br /> 949-261-1022(Tel) 949-260-3297(Fax) 9 G-As crbichlor 5-H25D4 <br /> { � ( } � � H.Ascorbic Aran T.TSP Dedecanydrate <br /> Email. w0#. m ? t-Ice U-Acetone <br /> J-Of water v-MCAA <br /> K-EDTA W-pH 4.5 <br /> Protect Name- Prof# J L-EDA Z-other(spectfy) <br /> Nestle-Ripon 72000256 <br /> n <br /> Site SSOW# w Other: <br /> n <br /> Sample Matrix z <br /> Type <br /> Sample (c=Comp, mw�ereba. <br /> e <br /> Sam Ve.Identification-Client ID Lab ID Sample Date TIM0 Gograb) BT-TWA,. Special InstructionslNote: <br /> P°, ,<<� "€' tel ,'.;•, <br /> CD as:aTl3 040318(720-85696-1) 413118 Pacific Water „ <br /> i X <br /> N 2: <br /> Oo 10:36 <br /> o 7501 KIERNAN 2008 EFF j(720-85696-2) 413118 Water X J:' <br /> N 7501 KIERNAN 2008 MID(720-85696-3) 413118 ©'38 Water XPacific <br /> 3, <br /> 7501 KIERNAN 2008INF(720-85696 ) 413118 t0'lfl Water X—Pac <br /> 8 <br /> 5725 HALL 2009 MID(720 85696 6 10:0`} 413!18 PacWater Xific <br /> 3, <br /> 5725 HALL 2009 INF(720-85696-7) 413198 10.12 Water X ,' <br /> pAgific <br /> 802 VERA EFF(720-85696-8) 413!18 1655 Water X 3:r <br /> Pacific l <br /> 802 VERA MID(720-85696-9) 413118 16'58 Water Xac Ic <br /> 3. <br /> 802 VERA INF{720-85696-10) 413118 17.01 Water XBlgffig� . , —f+fl <br /> 8, <br /> Note Since laboratory acrreditations are subject to change,TestAmenca Laboratories,Inc places the ownership of method,analyte 8 accreditation compliance upon out subcontract laboratories.Thls sample shipment is forwarded under chain-ofcustody N the laboratory does not <br /> currently maintain accreditation in the State of Ongin asted above for analysi3Aestslmatrlx being analyzed,the samples must be shipped back to the TestAmerica laboratory or other instructions will be provided Any changes to accreditation status should be brought to TestAmerica <br /> Laboratories,Inc.attention immediately If all requested aaxeditations are current to date,return the signed Chain of Custody attesting to said compkance,to TestAmerica Laboratories:Inc <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed ©Return To Client ©Disposal By Lab Archive For Months <br /> Deliverable Requested:I,Il,111,IV,Other(specify) Pnmary Deliverable Rank:2 Special InstructtonsIOG Requirements: <br /> Empty Kit Relinquished by: IDate. ITime, IMethod of Shipment• <br /> Relinquished by a Date/Tim C Received by Datums, Company <br /> v\ � <br /> Relinquished by, V DatelTtme- Company Received by Dateffime Company <br /> Op Relinquish Datelrme: Company Received by. DatelT r``E,[� Company-� �,_,r <br /> I j v'C'Il� � t?' <br /> O CUbody Sea Intact: Custody Seal No.: Cooler Temperature(s) nd her Re s <br /> 00 Yes No l In <br /> Ver:09/20/2016 n <br />