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TestAmerica Pleasanton I VIII I II IIIIIIIIIIIIIIIIIIIilllll I Ilillllllllll TestAmerica <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 THE LEADER IN ENVIRONMENTAL TESTING <br /> Sampler: Lab PM: Carrier Tracking Nola): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-33586.1 <br /> Client Contact: Phone: E-mail: State of Origin: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com California Page 1 of 1 <br /> Company: Accreditations Required(See note): Job#: <br /> Aquatic Testing Laboratories State Program-California 720-78844-1 <br /> Address. Due Date Requested: Preservation Codes: <br /> 4350 Transport#107, 4/14/2017 Analysis Requested A-HCL M-Hexane <br /> City: TAT Requested(days): "' B-NaOH N-None <br /> Ventura <br /> C-Zn Acetate O-AsNa02 <br /> State,Zip: -" n D-Nitric Acid P-Na204S <br /> m : <br /> CA,93003 o" E-NaHSO4 0-Na2SO3 <br /> Phone: PO �t <br /> WF-McOH R-Na2S203 <br /> #: m <br /> Ci G-Amchlor S-H2SO4 <br /> leo ' H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: n;1 I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> _ K-EDTA W-pH 4-5 <br /> Project Name: Project#: m L-EDA Z-other(specify) <br /> UPRR-Ret Tank-Stockton 72012176 "m <br /> Site: SSOW#: o_ y,. Other: <br /> a <br /> to <br /> Sample Matrix ; <br /> Type <br /> s- 11d, _ <br /> Sample (C=comp, 0 <br /> -.. .1.11, m <br /> Sample Identification-Client ID Lab ID Sample Date Time G= rab eT-Tlssue,A-Air w Special Instructions/Note: <br /> N <br /> Presematlion Code: <br /> 11:20 <br /> CD 3776-TANK(720-78844-1) 4/10/17 Water X } <br /> � Pacific <br /> UT <br /> O <br /> CJT <br /> W <br /> Note:Since laboratory accreditations are subject to change,TestAmerica Laboratories,Inc.places the ownership of method,analyte&accreditation compliance upon out subcontract laboratories.This sample shipment is forwarded under chain-of-custody. If the laboratory does not <br /> currently maintain accreditation in the State of Origin listed above for analysis/tests/matrix being analyzed,the samples must be shipped back to the TestAmerica laboratory or other instructions will be provided.Any changes to accreditation status should be brought to TestAmerica <br /> Laboratories,Inc.attention immediately. If all requested accreditations are current to date,return the signed Chain of Custody attesting to said complicance to TestAmerica Laboratories,Inc. <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed =Return To Client 0 Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements: <br /> Empty KitRelinquished,ay <br /> Date: Time: Method of Shipment: <br /> Relinquished by: _ DaterTime Company Received Date/Time. Comps <br /> Relinquished b Da ime: Company Receive Date/Time: Company <br /> N <br /> O Relinquished by: Daterrime: Company Received by: Daterrime: Company <br /> 1 <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: <br /> . Yes 4 No v <br />