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Tit <br />TestAmerica Pleasanton <br />1220 Quarry Lane <br />Pleasanton, CA 94566 <br />Phone(925)484-1919 Far(925)600-3002 <br />Chain of Custody Record <br />TestAmerica <br />THE LEADER IN EI—IRO—MENTAL TESTING <br />ampler: Lae PM: <br />Trariuq 1`05) <br />COG No: <br />Client Information (Sub Contract Lab) Sharma, Dimple <br />rflor <br />720-19664.1 <br />OWN cm wt Prions E - Mall: <br />Papa. <br />Shippvy/Recetwng dimple.sharma@testamenceiryc.com <br />Pape 1 of 1 <br />Company <br />Job f. <br />litAnalysis Requested <br />720.54010-1 <br />Addr— DIw Data Ratelptad. <br />Prsservatlon Codas: <br />4350 Transport A'107, ,711 T <br />Gly V1 TAY-FW—tad(days): <br />A - HCL M - Hexane <br />e - r/ <br />NaOH N-vN <br />VeMlxa <br />C - 2n AcMab O - ASNa02 <br />slst., Zip. <br />D - reek Ad P - MR2045 <br />CA. 93003 <br />E-NNis04 0-N42503 <br />R-NaS03 <br />F -MsOH 252 <br />G.Amtlid 5-H2SO4 <br />�wne: q. <br />= <br />H - Asowbt dd AT - TSP Dodacahydrra <br />I -Ica IJ - Malone <br />Ernara: O a <br />J -d W." v -MCAA <br />K - EDTA W - ph 4-5 <br />L - EDN 2 - dnr (Wwty) <br />Ftol.a Name: Protect IT: <br />UPRR-Filler Bin Stockton, CA 72006903 <br />; <br />011W. <br />Sae: SSOWM. <br />F' - <br />Matrix <br />Sample <br />Type <br />Sample (CKCww, <br />Sample Ident"icatlon • Client ID Lab tDj Sample Date Time rab) <br />Special InstructloruMote: <br />UPS131111-1 (720-54010-1) 11/11/13 08:00 Solid <br />X <br />own <br />UPS 131111-2(720-54010-2) 11/11/13 Sold <br />X <br />108: <br />Jim <br />Possible Hazard /dentIncatlon Sam Disposal (A fee maybe assessed K samples are retained taper than 1 month) <br />Unccnfirawd 175– To Clrent Disposal B Lab Archive For Months <br />Deliverable Requested: I, It. W. IV, other (specify) Special InstnlctionstW Requirements: <br />Empty Kit Relinquished by: Dale: Time: M.arod d Shpmenl: <br />Relwgmhad C Recw <br />/DaN+T <br />`l/ <br />ReanOnlahed D . .,n.. C DaM' Da Wim.: Coalprry <br />Wluguuh.d Dy DaWTima: Camparry RogiliNed by Dat.ltlm.: Company <br />Culody Seats Intal <br />Custody Seal No.: Coder Tempuabxa(.)'C and C4W wmads: <br />es a No <br />0 <br />N <br />N <br />tT <br />N <br />CL <br />(V <br />CD <br />(D <br />CD <br />CD <br />