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Test Quarry <br /> L Lane <br /> Pleasanton Chain of Custody Record I N I�I� Il 1pTestAmedca <br /> 1220 Quarry Lane <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 Tirr t.ranra a�r+avioa vn�rvrA rr5r•ti� <br /> Sampler Lab PM. Carr}er Tracking No(s) COC No <br /> Client information (Sub Contract Lab) smith,Micah y Y3 s y J 720-38934.1 <br /> Client Contact Phone- E-Mail: State of Origin. Page <br /> Shipping/Receiving micah.smith@testamericalnc.com California Page 1 of 2 <br /> Company Accreditation Required(See note). Job#- <br /> TestAmerlca Laboratories,Inc NELAP-California,State Program-Caldorno 720-87315-1 <br /> Address. Due Date Requested- Preservation Codw <br /> 17461 Denan Ave, Suite 100, 7/16/2018 Analysis Requested A-HCL M-Hexane <br /> City TAT Requested[daysi: t B-NaOH N-None <br /> Irvine C-Zn Acetate 0-AsNa02 <br /> State,Zip D-Nitric Acid P-Na2O4S <br /> CA,92614-5817 m E-NaHSO4 O-Na2SO3 <br /> Phone PO# F-MSOH R-Na25203 <br /> 949-261-1022(Tel) 9 H-As <br /> 49-260-3297(Fax) -As-H2so4 <br /> :e � H corbicrbw Acid T-TSP Doderahytlrate <br /> Email WO#� <br /> Y �_ I-Ice U-Acetone <br /> J-DI Water V-NCAA <br /> Project Name Project#- # <br /> K-EDTA W-pH 4.5 <br /> Nestle-Ripon 72000256 L-EDA Z-other(specify) <br /> Site SSOW# a Other: <br /> m � <br /> m <br /> Sample Matrix i <br /> Type {w-w, . D <br /> mp <br /> =co ,C <br /> Sample ' i <br /> p � O-wub/ai, 'Q <br /> Sam a Identification-Client ID Lab ID IS Ie Date Time G= rab eT-n--,A.Nr � Special Instructions/Note: <br /> Preserlation Codi: <br /> N <br /> CD TB-070318(720-87315-1) 7/3118 P6.45 Water X ' <br /> 4 7501 KIERNAN 2008 EFF(720-87315.2) 713118 09:35 Water X 3 <br /> O Pa ift <br /> 40 <br /> Cn 7501 KIERNAN 2008 MID(720-87315-3) 713118 P9' a Water X 3 <br /> N <br /> 7501 KIERNAN 20081NF(720-87315-4) 7!3118 09:44Pacifi Water X 3, <br /> 5725 HALL 2009 EFF(720-87315-5) 713118 P10.04 Water X 'J <br /> cific <br /> 5725 HALL 2009 MID(720-87315-6) 7/3118 10:09 Water X 3 <br /> Pacific <br /> 5725 HALL 2009 INF(720-87315-7) 713118 1013 Water X 3 <br /> Pacific <br /> 361 PARALLEL(720-87315-8) 713118 11.04 Water X 3 <br /> acifRC-1(720-87315-9) 713118 11.56 Water X 3 <br /> Pa ific <br /> Note,Since laboratory accreditation are subject to change,TestAmerica Laboratories,Inc places the ownership of method,analyte 8 accreditation compliance upon out subcontract laboratories. This sample shipment is forwarded under Cho€n-of-custody If the laboratory does not <br /> currently matntam accreditation in the State of Origin listed above for analysisftests/matrix being analyzed,the samples must be shipped back to the TestAmedca laboratory or other instructions will be provided, Any changes to accreditation status should be brought to TestAmenca <br /> laboratores,Inc attention immediately.q all requested accrednations are current to date,return the signed Chain of Custody attesting to sand compiscance to TestAmerica Laboratories,Inc <br /> Possible Hazard ldentiffcatfon Sample Disposal(A fee may be assessed If samples are retained longer than 1 month) <br /> Unconfirmed ©Retum To Client ©Disposal By Lab ©Archive For Months <br /> Deliverable Requested:1,II,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instruc' s/QC Requirements: <br /> Empty Yit Rel• quished by Date: Time. Method of Shipment <br /> Ralirtq y DatwTi e7 Co Re ervetl by patelli e. Company <br /> Reim wsheer by Dateffi a Company Received by D n; Company <br /> v <br /> Relingtntied by. Daterrime, Company Received by Dater rime- Company <br /> CD <br /> O Custody Seals Intact" t ustody Seal No.: Cooler Temperature(s)°C and Other Remarks, <br /> 00 o No cz e.2 fZ , <br /> Ver.09/20/2016 <br /> e � nn n <br />