Laserfiche WebLink
TestAtrterica Pleasanton TestmeneCO <br /> 1220 Quarry Lane Cham of Custody Record <br /> Pleasanton, CA 94566 <br /> -i+r,rnnr+r IN r•jw,aa•rn•r-trnc-rsritir; <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM Camer Tracking No(s),r�- COC No <br /> Client Infoftnation (Sub Contract Lab) Smith,Micah l!✓7 ° ,r d 2 -ZC 720-38934.2 <br /> Client Contact, Phone, E-Mad State of Ongm, Page <br /> Shipping/Receiving micah.smlth@testamericainc.com California Page 2 of 2 <br /> Company- Accred,taticins Required(See note), Job# <br /> TestAmerica Laboratories,Inc NELAP-California;State Program-Califomia 720-87315-1 <br /> Address Due Date Requested: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 7/16/2018 Anal is Requested A-HCL M-Hexane <br /> City. TAT Requested(days): i 6-NaOH N-None <br /> Irvine o- C-Zn Acetate 0-AsNaO2 <br /> State.Zip. S i D-Nitnc Acid P-Na244S <br /> CA,926145817 m E-NaHSO4 Q-Na2SO3 <br /> Phone PO# 3' ; P-McOH R-Na25203 <br /> ` G-Amehlor S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) m H-Ascorbic Acid T-TSF Dodecahydrate <br /> Cmaii WO N. r� <br /> -i I-ICe U-Acetone <br /> `•j J-Dt Water V-MCAA <br /> Protect Name, Project#• m 3 K-EDTA W-pH 4-5 <br /> Nestle-Ripon 72000256 L•EDA z-Other(specify) <br /> Site, SSOW# a other; <br /> Sample Matrix z <br /> Type <br /> Sample (C=Comp, <br /> Sample Identification-Client ID Lab ID Sample Date Time G=grab) 0T-TI.w..M*r n 1 fteclat Instructlonslllote: <br /> _ prftwatt(3h 00(w," <br /> CD 7971 KIERNAN(720-87315-10) 7/3118 Pacific acifi Water X 3 <br /> 000 1051 ROBERT(720-87315-11) 713118 Pacific Water X 3 <br /> a <br /> Cn 5724 HALL(720-87315-12) 7!3118 P�if Water X 3 <br /> N <br /> Note,Since laboratory accreditation are subject to Change,TestAmerioa Laboratories,Inc places the ownership of method,analyte&accreditation compliance upon out subcontract laboratories. This sample shipment is forwarded under chain-of-custody I <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed I =Return To Client ©Disposal By Lab Archive For Months <br /> Deliverable Requested:1,11,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instr I Requirements: <br /> Emp Kit Re nquished by: Date Time Method of Shspment <br /> Ret, qui ed b Oate/rip� 7 �( Co ny Rac ved by Daterrime ,/ Com-pyany <br /> Reli uish by Oat/ ime I ompany Received by D elTime Company <br /> v <br /> Relinquished by DatelTime• Company Received by DatelTime, Company <br /> 00 1 <br /> N) Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and other Remarks: <br /> [A 1.2 <br /> 00 Ver 09120124€6 <br />