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Teo QmeLaca Pleasanton I <br /> Chain of Custody Record �llllIIIIII�IlIII�I��IlIIIII�II� Test medca <br /> Pleasanton, CA 94566 <br /> -1{F I rArSFA Iry F'J'JIAOkN r`:TA+. 71`S71tFr, <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking Niels): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-33572.1 <br /> Client Contact: Phone: E-Mail: State of Origin: Page; <br /> Shipping/Receiving dimple.sharma@testamericainc.com Cli <br /> afornia Page 1 of 1 <br /> Company: Accreditations Required(See note): Job#: <br /> TestAnr ica Laboratories,Inc State Program-California 720-78844-1 <br /> Address: Due Date Requested: Preservation Codes: _ <br /> 17461 Derian Ave, Suite 100, 4/18/2017 Analysis Requested A-HCL M-Hexane <br /> city: TAT Requested(days): B-NaOH N-None <br /> Irvine C-Zn Acetate 0-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> CA,92614-5817 " E-NaHSO4 0-Na2SO3 <br /> F-McOH R-Na2S203 <br /> Phone: PO#: <br /> G-Amchlor S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) H-Ascorbic Add T-TSP Dodecahydrate <br /> Email: WO#: I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> K-EDTA W-pH 4-5 <br /> Project Name: Project#: <br /> UPRR-Ret Tank-Stockton 72012176 ci L-EDA Z-other(specify) <br /> 0 <br /> Site: SSOW#: g''n Other: <br /> W U , <br /> Sample Matrix Omi <br /> Type <br /> Sample (C=comp, o-w..nroa, <br /> Sample Identification-Client ID Lab ID Sample Date Time G=grab) BT-Tosu.,A-a,1 w $ Special InstructionslNote: <br /> a) Preservation Code: X <br /> (D 11:20 <br /> 3776-TANK(720-78844-1) 4/10/17 Pacific Water X 1+ <br /> v <br /> O <br /> Cn <br /> W <br /> Note:Since laboratory accreditation are subject to change,TestAmerica Laboratories,Inc.places the ownership of method,analyte 8 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 I <br /> =Return To Client =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 Kit Relinquished by: Date: Time: Method of shipment: ` <br /> £F <br /> Relinquished by: Date/Time: f C pany Received by: } Date/Time: <br /> n <br /> Relinquished by: Date/Time: Company Received by: V Datenrime: Company <br /> CD <br /> ORelinquished by Date/Time: Company Received by: Daterrime: Company <br /> _ <br /> v <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: X/y <br /> A Yes A No <br />