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TestAmerica Pleasanton II�IIIII IIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII t'�r`stAme6c <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 Tifff-,LrAorR M ENVIRQNWNTAL TrSTINC <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: I <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38933.1 <br /> Client Contact: Phone: E-Mail: State of Origin: Page: <br /> Shipping/Receiving miaah.smith@testamericainc.com California Page 1 of 1 I <br /> Company: Accreditalions Required(See note): Job#: <br /> TestAmerica Laboratories,Inc. NELAP-California;State Program-California 720-87315-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2417 Bond Street, 7/16/2018 Analysis Requested <br /> A-HCL M-Hexane <br /> City: TAT Requested(days): _ B-NaOH N-None <br /> University Park C-Zn Acetate 0-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> IL,60484 -_ - E-NaH504 Q-Na2SO3 i <br /> F-McOH R-Na2S203 <br /> Phone: PO#: __' G-Amchlor S-H2SO4 <br /> 708-534-5200(Tel) 708-534-5211(Fax) o H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: I-Ice U-Acetone <br /> `p J-DI Water V-MCAA <br /> u "d K-EDTA W-pH 4-5 <br /> Project Name: Project#: -e L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256y $ c: <br /> site_• SSOW#: _7�0-87315 COC _ -°' _F e°>- other: <br /> ^e o 0 <br /> tn. <br /> I <br /> Sample Matrix w �l <br /> Type (wwala, o <br /> 3=solid, <br /> iz <br /> z <br /> Sample Date Time G=grabSample (C=comp, o=--t.1.11' d N <br /> Sample Identification-Client ID Lab ID r=naaua,A=a <br /> 'LL _ $ �.. Special Instructions/Note: <br /> _ — <br /> preservation Code:_ ` <br /> 10:04 <br /> 5725 HALL 2009 EFF(720-87315-17) 7/3/18 Water X 1=` <br /> Pacific <br /> - - II <br /> Note:Since laboratory accreditation are subject to change,TestAmerica Laboratories,Inc.places the ownership of method,analyte&accreditation compliance upon out subcontract laboratories. This sample shipment is forwarded under chain-of-custody.If the laboratorydoes not <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 <br /> Laboratories,Inc.attention Immediately. If all 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 /> i <br /> Unconfirmed Return To Client Disposal By Lab Archive For Months <br /> Deliverable Requested:I,Il,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements: <br /> E y it Relinquished by: Date: Time: Method of shipment: <br /> linqu' d try: Dat im Com any Recei ed by: Date/Time: Company <br /> Rel nquis d by: Dat 1 Company Received y: Date/Time: Company <br /> Relinquished by: Date/Time: Company Received by: Date/Time: Company <br /> Custody Seals Intact: Custody Seal,No.: Cooler Temperature(s)°C and Other Remarks: rr�•�ff ,, <br /> A Yes o No D'co J <br /> 018 <br /> Ver:09/20/201 <br />