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am <br />N <br />N <br />W <br />IV <br />CD <br />M <br />TestAmerica Pleasanton <br />1220 Quant' Lane <br />Pleasanton, CA 94566 <br />Phone (9251484-1919 Fax(925)600-3002 <br />Chain of Custody Record fll�ll�lllggl TestAmerica <br />THE. LEADER IN ENVIRONMENTAL TESTING <br />Client Information (Sub Contract Lab) <br />Sampler. <br />Lab PM: <br />Sharma, Dimple <br />Carrler Tracking "s): <br />I <br />COC NO: <br />720-27547.1 <br />Client Contact: <br />Shipping/Receiving <br />Phone: <br />E-Mait: <br />dimple.shanma@tastamericainc.com <br />Pape: <br />Page 1 of 1 <br />Company. <br />Aquatic Testing Laboratories Mal Is Requested <br />Job #: <br />720-69889-2 <br />Address: <br />4350 Transport #107, <br />Due Date Requested: <br />2/4/2016 <br />Preservation Codes: <br />A -HCL M -Hexane <br />8 - NaOH N - None <br />C - Zn Acetate 0 - ASN302 <br />D - We Add P - Na204S <br />E - NaHS0�4 0 - Ka2S03 <br />T2 - Na262603 <br />G - Amchlor S - H2SO4 <br />H - Ascorbic Add T - TSP Doderahydrate <br />I - Ice U - Acetone <br />J - DI Water V - MCAA <br />K - EDTA W -ph 4S <br />L -EDA Z -other (spedfy) <br />Omer: <br />City <br />Ventura <br />TAT Requested (days): <br />State, Zip: <br />CA, 93003 <br />Phone. <br />PO N: m <br />Ernall: <br />WO ir: ; <br />= <br />Project Name: <br />UPRR-Stockton <br />Project e: <br />72003657 <br />Site: <br />SSOW n: <br />io <br />a <br />Sample Identification - Client ID ID <br />DL -LOC- (720-69889-1) <br />Sample Date <br />1121/16 <br />Sample <br />Time <br />9:40 <br />cific <br />Sample <br />Type <br />(C=comp, <br />G=grab) <br />Matrix 3 <br />(N..... i <br />o.. w, a, m <br />n-ni Mm a' <br />Water X <br />Special Instructions/Note: <br />Possible Hazard Identification Sample Disposal (A lee may be assessed If samples are retained longer than 1 month) <br />Unconfirmed Return To Client = Disposal By Lab Archive For Months <br />Deliverable Requested: I, II, III, IV, Other (specify) Special Instructions/QC Requirements: <br />Empty Kit Relinquished by: Dale: Time: Med>od of Shipment: <br />Ratirp Ashed by <br />Dalen! <br />- <br />C n <br />Received b <br />D.terTane: <br />in <br />Relinquished by <br />DatsMrne: <br />Company <br />Recei <br />m ime: <br />Company <br />Relinquished by <br />DataMrne: <br />Company <br />Rer by <br />Dateriane: <br />Corpany <br />Custody Seals Intact <br />a�XOS A Ni <br />Custody Seal No.: <br />Coder Temperawre(s) "C and Omer Rernerics: <br />t <br />