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TestAmarica Pleasanton J 1 111111 ll Teat}A mefica <br /> 1220 Quarry Lane Chain of Custody Record ! JIT't! <br /> Pleasanton, CA 94566 <br /> TkE LEADER!H ENVIRONMENTAL TF.I371NC <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM Camlar Tracking No(s). COC No' <br /> Client information (Sub Contract Lab) Smith,Micah 720-39236.1 <br /> Omni Contact- Phone, E-Mail' State of Origin Page <br /> ShippingiReceiving micah.smith@testamericainc.com Callfomia Page 1 of 1 <br /> Company Accraddatrons Reqwred(See ri&0 Job# <br /> TestAmerica Laboratories,Inc NELAP-California;State Program-California 720-87896-1 <br /> Address Due Date Requestevi: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 8121/2018 Analysis Requested A-HCL M.Hexane <br /> City, TAT Requested(days): •t;.; c�' B,NaCH N-None <br /> Irvine ' C-Zn Acetate 0-AsNaD2 <br /> State,Zap �t <br /> D-Nitric Acid P-N8204S <br /> CA,92614-584 7 E-NaHSO4 Q-Na2SO3 <br /> Phone PO#• , F-McOH R-Na?5203 <br /> Q�+ ; �', G-Amchlor S.H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) H-Ascorbic Aad T-TSP Dodecahydrate <br /> Erna, WO# I-Ice U-Acetone <br /> • J-DI Water v-MCAA <br /> a <br /> '• K-EDTA W-pH 4.5 <br /> Protect Name Prof# <br /> Nestle 72000256 L-EDA Z-other(specify) <br /> � � <br /> Site SSOW# ; i ;Other. <br /> n <br /> Sample Matrix i <br /> T (w= t r. <br /> YID a <br /> Sample (c=Gump, oaueate., <br /> Sam le Identification-Client ID "It,lb Sample Date Time G= rah) aT•Ti__,A=Ak n + Special Instructions/Note: <br /> (720-87896-4) 81Tl18 Pacific Water " t ' ) t',';" .1 <br /> CD TB-080718ter X <br /> 0 7501 KIERNAN 2008 EFF(720-87896-5) 817118 P10:50 Water X ic <br /> 4�, 7501 KIERNAN 2008 MID(720-87895-6) 8/7!18 10:55 Water X �. <br /> Pacific <br /> 7501 KIERNAN 2008 INF(720-87896-7) E,7 <br /> 11'00 Water X �3f <br /> Pacific <br /> 5725 HALL 2009 EFF(720.87896-8) 10'30 Water X 3' <br /> Pacific <br /> 5725 HALL 2009 MID(720-87896-9) acifi Water X5725 HALL 2009 INF(720-87896-10) 1 c I Water Xacific1051 ROBERT(720-87896-11) 08:30 Water X 9, <br /> Pacific <br /> 05 <br /> MW-3(720-87896-12) &7ifS Pacific PacifiWater X a <br /> Note Since laboratory accreddations are subleO to change,TeVAmenca Laboratones,Inc places the ownership of method,ana€yle&accreditation compliance upon out subcontract taboratones This sample shipment is forwarded under Cham-of-custody If the laboratory does not <br /> currently maintain accredttatmn in the State of Ongin listed above for analysisltestslmatnx bung ana#yzed,the samples must be shipped back to the TestAmenca laboratory or other intiruavons mil be proMed Any changes to accreditation status should be brought to TestAmenca <br /> Laboratories,Inc attentton smmediately If all requested accreditation are current to date,return the signed Chain of Custody attesting to said compikance to TeslAmenca Laboratones,Inc <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than i month) . <br /> Unconfirmed I =Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested I,11,Ill,IV,Other(specify) Primary Deliverable Rank:2 Speciaf instructions/QC Requirements: <br /> Em2kKil Relinquished by: Date Time: Method of shipme t <br /> Relmqu Dat -�r,. Comp e <br /> R ingw ed by Datefrime rLCI Company Welled by Dat i Co any <br /> Co <br /> I j Relinquished by D.I.Mma Company Received by DatelTime Company <br /> IV <br /> CD <br /> O CUSt ealsIntact: Custody Seal No.: Cooler Tempereture(s)°Cand Other Remarks <br /> 00 A No <br /> 00 Ver•09/2012016 <br />