Laserfiche WebLink
estAmerica Pleasanton <br /> 12TerstA 1 1 ►hca <br /> Plea Quarry ton, CA <br /> Chain of Custody Record <br /> Pleasanton, CA 94568 <br /> Phone(925)484-9919 Fax(925)600-3002 T14F LEAVER IN FHVIR[1NMENTAr TESTING <br /> Sampler Lab PM Camer Tracking No(s) COC No <br /> Client Information (Sub Contract Lab) Smith,Mica �7k 2 720-38941.1 <br /> Chant Contact Phone E-Mall State of Origin Page <br /> Shipping/Receiving imicah.smith@testamericainc.com California Page 1 of 1 <br /> Company Accreditations Required(See note) Job# <br /> TestAmerica Laboratories,Inc NELAP-California,State Program-California 720-87316-1 <br /> Address Due Date Requested: Preservation Codes: <br /> 17461 Derlan Ave, Suite 100, 7/1812018 <br /> 11812018 Analysis Requested A-HCL M-Hexene <br /> City TAT Requested(days): �; E-NaOH N-None <br /> Irvine C-Zn Acetate 0-AsNa02 <br /> State,Zip '��,"•:; D-Nitnc Acid P-Na204S <br /> CA,92614-5817 ;i'', <br /> •�' E-NaHSO4 0-Na2SO3 <br /> Phone. PO# F-McOH R-Na2S203 <br /> a° <br /> 949-261-1022(Tel) 949-260-3297(Fax) G-Amch[or S-H2SO4 <br /> m H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email W O# > 1 I-Ice U-Acetone <br /> > •; J-DI Water V-MCAA <br /> •� K-EDTA W-pH 4-6 <br /> Protect Name Protect# ; �• ' <br /> Nestle-Ripon 72000256 L-EDA Z-other(specify) <br /> Site SSOW#. <br /> 'r< Other: <br /> Sample Matrix J t ; <br /> Type ,. �' �t z. <br /> Sample (C= a�.". <br /> comp, os". d N <br /> Sam le Identification-Client ID Lab ID) Sample Date Time G=grab) at•Tss.e.,A-Au Special:Instructions/Note: <br /> v. a <br /> (D ) Pa.07 Water <br /> MW-3(720-87316-21 713118 X <br /> � <br /> MW-7(720-87316-22) 713118 P7-i is Water X <br /> 0 07:2 <br /> MW-10(720-87316-23) 7!3118 Pacific Water X ;' <br /> MW-7 DtJP(720-87316-24) 713118 07,17 Pacific <br /> Water X <br /> 11.., <br /> Note Since laboratory accreditabons are subject to change,TestAmerca Laboratories,inc places the ownership of method,analyte 8 accreditation compliance upon out subcontract laboratones This sample shipment is forwarded under chain-0f-custody If the laboratory does not <br /> currently maintain accreditation in the State of Origin listed above for analysisltestslmatnx being analyzed,the samples must be shipped back to the TestAmarica laboratory or other instructions will be provided Any changes to accreditation status should be brought to TestAmenoa <br /> Laboratories,Inc attention immediatety If all requested accreditation are current to date,return the signed Chain of Cv atody attesting to said comphcance to TestAmenca Laboratories,Inc <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than f month) <br /> Unconfirmed M Return To Client =Disposal By Lab ©Archive For Months <br /> Deliverable Requested:1,II,III,IV,Other(specify) Primary Deliverable Rank:2 Special lnstTuctlon51QC Requirements. <br /> pty Kit elinqu€shed by: Date. Tame: Method of shipment <br /> eh uish ylz� Det : Co R vedby Daterrme n Company <br /> elm shad Ky Date me Company Received by DotaMmA Company <br /> v <br /> Relinquished by Daterrime Company Received by DatelTime Company <br /> 00 <br /> CD CuCD s als intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks -r %�Y <br /> Yes A No x <br /> Ver:01)/20/2016 <br />