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TestAaneraCa Pleasanton Chain of Cus#ody Record I III l� N�lI �NI�I I TestAmerica <br /> 1220 Quarry Lane <br /> Pleasantan, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 rNr Lranra,w Fwvvanwuawrgt rrsn vc <br /> Sampler Lab PM Carrier Tracking No(s) COC No- <br /> Client Information {Sub Contract Lab) smith,Micah 720-39060.1 <br /> Client Conlact Phone E-Mad State of Ongvn Page <br /> Shipping/Recetving nnicah.smith@testamencainc com California Page 1 of 1 <br /> Company Accreddatmns Required(See nota= Job# <br /> TestAmenca Laboratories,Inc NELAP-California;State Program-California 720-87523-1 <br /> Address Due Date Requested Preservation Codes: <br /> 17461 Denan Ave, Suite 100, 7/3112018 Analysis Requested A-HCL M-Hexane <br /> City TAT Requested tdaysl: 8-NsOH N-None <br /> Irvine C-Zn Acetate 0-ArNa02 <br /> State Zip D-Mind Acid P-Na204S <br /> CA,9261E_5817 m E-NaHSO4 0-Na2SO3 <br /> F 14,50H 9,-N225203 <br /> Phony PO# <br /> 949-261-1022(Tel) 949-260-3297(Fax) H-As-Accororbicbic S-H2SO4 <br /> w H Aad T-TSP podecahydrate <br /> Email 70# :3 •• 1-Ice U-Acetone <br /> > J-Di Water V-MCAA <br /> K-EOTA W-pH 4-5 <br /> Protect Name Project# o L-EDA Z-other(sp"fy( <br /> Nestle 72000256 <br /> site SSOW# c'' <br /> a Other: <br /> a <br /> Sample Matrix z° <br /> Type <br /> Sample (C=camp, <br /> Sam Ele Identification-Client ID Lab ID Sample Date Time G=grab) T.T., ,A-JAA F. Special Instructions/Note: <br /> i5i §btlrAt3tSti add: € <br /> N TB-071718(720-87523-1) 7117118 07:30 1 WaterX 2 <br /> N Pacific <br /> o 30 7501 KIERNAN 2008 EFF(720-87523-2) 7/17/18 08; Water X 3 <br /> fV 7501 KIERNAN 2008 MID(720-87523.3) 7117/18 P8 35 Water X 3 <br /> 5725 HALL 2009 EFF(720 08:55 Pacific 7117118 P Ifc Water X 3, <br /> 5725 HALL 2009 MID(720-87523-5) 7/17118 09,00 Water X '$ <br /> Pacif€c <br /> 802 VERA EFF(720.87523-6) 7117!18 10:15 Water X :3 <br /> Pacific <br /> 802 VERA MID(720-87523-7) 7/17118 10:20 Water X 9' <br /> Pacific <br /> 802 VERA INF(720-87523-8) 7117/18 10:25 Water X S' <br /> Pacific <br /> Note Since laboratory accreditation are subject to change.TestAmence Laboratones,Inc places the ownership of method.analyte&accreditation compliance upon out subcontract laboratories This sample sh,f merit is forwarded under cham-of-custody Ifthe laboratory does not <br /> currently maintain accreditation in the State of Origin tisfed above for anatysmiterWi atnx being analyzed,the samples must be shipped back to the TestAmenca laboratory Or other snsiructions will be provided Any changes to accreditation status should be brought to TestAmerrca <br /> Labcrator=es,Inc attention immediately If all requested accreddations are current to date,return the signed Chain of Custody attesting to said compltcance to TestAmenca Laboratanes,Inc <br /> Possible Hazard ldentfication Sample Aisposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed ©Return To Client ©Disposal 8 Lab ©Archive For Months <br /> Dellverabte Requested.1,Il,111,1V,Other(specify) Primary Deliverable Rank:2 Special Instructions=Requirements: <br /> Empty Kit Relinquished by- Date: Time. Method of Shipment <br /> Relinquished by 1 OateMme - Cn a R d D , Co <br /> vz <br /> Relinquished by Oate Mme Company ReceWd by- Dat,; Mm pany <br /> v <br /> IV Relinquished by OatelTMme Company Received by Oatefl'Mme Company <br /> v <br /> N <br /> CD Cu Seals Intact, Custody Seal No., Cooler Temperatures)°C and Other Remarks <br /> CO4Ye ANo t f- � <br /> Ver:09/20/2016 <br /> n <br />