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N <br />W <br />N <br />O <br />U <br />N <br />N' <br />CD <br />CD <br />00 <br />CD <br />TestAmerica Pleasanton <br />1220 Quarry Lane <br />Pleasanton, CA 94566 <br />Phone(925)484-1919 Pa. tg25) 6110.007 <br />Chain of Custody Record II�V9u�plllll �II�NI�III� I��I <br />i <br />TestXmedca <br />TME LEADER 11 ENVIRLINYENTAL TESTINQ <br />Sampler: Lab PM: <br />Carder Tracking tJof sl: <br />c -- <br />Client Information (Sub Contract Lab) Sharma, Dimple <br />720-27458.1 <br />Cllam Contact Pnone: E -Mall: <br />Page: <br />Shlpping/Receiving dimple.sha"a@testamericainc.com <br />Page 1 of 1 <br />Company. <br />Job M: <br />TestAmerica Laboratories, Inc <br />Analysis Rec uested <br />720-69888-1 <br />Address: Due Date Requested: <br />Preservation <br />odes: <br />17461 Derian Ave, Suite 100, 1/25/2016 <br />A -HCL <br />D - N.OH <br />M - Hazane <br />N - None <br />City TAT Regeeated (days): <br />Irvine <br />C - Zn Acetal. <br />O - AsNa02 <br />Sfaba, Zip: <br />D -NIIrIc Add <br />P-Na204S <br />CA, 92614-5817 <br />E-N.HSO4 <br />F - MeOH <br />0-Na2S07 <br />- - <br />5-H2504 <br />Phone: PO M: <br />G - r <br />161 - <br />!i <br />H -Ascorbic ACIN <br />I - Ice <br />I T - TSP Dodecahydrale <br />U - Acetone <br />FinailWDM: <br />i <br />J - DI Water <br />K - EDTA <br />V -MCAA <br />W - ph 4-5 <br />Protect N.prnlecl M: <br />UPRR-Stockton 72003657 <br />os <br />E� <br />_ <br />1 -EDA <br />Other. <br />Z - othw(specify) <br />Site: SSOWM: <br />yyy <br />m <br />� <br />Sample <br />Matrix <br />3 <br />m <br />Type <br />Sample (C=comp, <br />o.�rr«� <br />3 q <br />7 <br />Sample Idanuflcatlon - Client ID Lab ID Sam le Date Time G= rob <br />AL <br />Special InclructionsMota: <br />Pfeseryatlon Code: <br />BS-ONESPOT-(720-69888-1) 1/21/16 11:30 Solid <br />X <br />X <br />X <br />1 <br />P iii <br />L� <br />Possible Hazard Identification Sample Disposal (A fee may be assessed If samples are retained longer the 1 month) <br />d '=Disposal <br />Unconfirmed Return To Client By Lab Archim For Months <br />Deliverable Requested: I, II, III, IV, Other (specify) Special Instnlctfons/QC Requirements: <br />Empty Kit Relinquished by. Date: Time: Method of Shlpmenc <br />Rairquished by G <br />Mme r� Recelveo by. DaleRlme: Conpany <br />/ <br />Relinquished by <br />te✓T Company Received by DatisTlme: Company <br />R ImL4ahed by: <br />D.i.M e' Company Race Dalarr Compen <br />/ <br />Custody Seals Intact: Custody Seal No.: coder amper.wre(s)'C a <br />A Yes d No <br />