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I <br /> TestAmerica Pleasanton IIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Test me Hca <br /> 1220 Quarry <br /> Lane <br /> Pleasanton, CA 94566 Chain of Custody Record <br /> Phone(925)484-1919 Fax(925)600-3002 THE r r-noFe rw rwvrecrwut wrnL rrsrlwc <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Smith,Micah 720-37983.1 <br /> Client Contact: Phone: E-Mail: State of Origin: Page: <br /> Shipping/Receiving micah.smith@testamericaine.com California Page 1 of 1 <br /> Company: Accreditations Required(See note): Job#: <br /> TestAmerica Laboratories,Inc. NELAP-California;State Program-California 720-85696-1 I <br /> Address: Due Date Requested: Preservation Codes: <br /> 2417 Bond Street, 4/16/2018 Analysis Requested A-HCL M-Hexane <br /> City: TAT Requested(days): _ �,` B-NaOH N-None <br /> University Park _ C-Zn Acetate O-AsNa02 <br /> State,Zip: :_- -_ D-Nitric Acid P-Na204S 1 <br /> 1L,60484 E-NaHSO4 O-Na2SO3 <br /> F-McOH R-Na2S203 <br /> Phone: -- <br /> 708-534-5200(Tel) 708-534-5211(Fax) .c w H-Ascorbic Acid T-TSP Dodecahydrate { <br /> Email: WO#: Z I-Ice U-Acetone <br /> J-Dl Water V-MCAA <br /> K-EDTA W-pH4.5 <br /> Project Name: Project#: ; <br /> p « L-EDA Z-other(specify) i <br /> Nestle-Ripon 72000256 d; o c- i <br /> Site: SSOW#: iE Other: <br /> 99- <br /> Sample <br /> :Sample Matrix <br /> Type <br /> (W—ter,s-wild <br /> Sample (C=Comp, owW.11, ,r�LL. ND <br /> Sample Date Time G= taer=rss�e, , ''e <br /> 1. <br /> l ctions/Note:Sample Identification-Client ID Lab ID Special nstru <br /> Pres&rvatioi1C6de„_ . <br /> I <br /> 5725 HALL 2009 EFF(720-85696-5) 4/3/18 Pacific Water X 1` <br /> i <br /> i <br /> t <br /> = p <br /> 720-85696 COC <br /> — - - --- <br /> Note:Since laboratory accreditations are subject to change,TestAmerica Laboratories,Inc.places the ownership of method,analyte 6 accreditation compliance upon out subcontract laboratories.This sample shipment is forwarded under chain-of-custody.tithe laboratory does not I <br /> currently maintain accreditation in the State of Origin listed above for analysis/tests/matrix'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 I <br /> Laboratories,Inc.attention immediately. [fall requested accreditations are current to date,return the signed Chain of Custody attesting to said complicance 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,II,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements: i <br /> Empty Kit Relinquished by: Date: Time: Method of Shipment: <br /> Relinquished y: Dat9” e: C Received b. Date Company <br /> Relinquished by: Data e: Comps y Receiv d Date ime: Company— <br /> Relinquished <br /> ompany Relinquished by: Dalefrime:. Company Received by: Datefrime: Company it <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: s + \. �J <br /> A Yes A No L -4 v <br /> Page 29 of 32 Ver:09/20/2016 4/18/2018 <br />