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TestAmerica Pleasanton I IIIIIIII IIIIIIIIIII II�II�IIIIIIIIIIIIIIIIIIII III TestAmedca <br /> Pleasanton, CA 94566 Chain of Custody Record <br /> THE ucAora IN rWv+RONMENTAr rrsnNc <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-33584.1 <br /> Client Contact: Phone: E-mail: State of Ongin: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com California Page 1 of 1 <br /> Company. Accreditabons Required(See note): Job#: <br /> TestAmerica Laboratories,Inc State Program-California 720-78844-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 4/14/2017 Analysis Requested A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Irvine C-Zn Acetate O-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> CA,92614-5817 E-NaHSO4 O-Na2SO3 <br /> F-McOH R-Na2S203 <br /> Phone: PO#: G-Amch or S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) e H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: r I-Ice U-Acetone <br /> J-Dl Water V-MCAA <br /> Project Name: Project#: c K-EDTA W-pH 4-5 <br /> UPRR-RetTank-Stockton 72012176 A0 L-EDA Z-other(speciry) <br /> f <br /> Site: SSOW#: E = u �. Other: <br /> t�, 3 <br /> al m <br /> Sample Matrix I N! a 0 <br /> NI <br /> Type (W—ate,, o z . <br /> Sample (C Comp, 0__.,.I,, o 01 <br /> N <br /> Sam le Identification-Client ID Lab ID Sample Date Time G=grab) BT-Ti—,A-Ar IL N Special In <br /> a) Preservation Code: ; <br /> C 3776-TANK(720-78844-1) 4/10/17 11:200 Water X X X XPacifi <br /> 5 <br /> Co <br /> O <br /> Cn <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/testsimatrix 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 TestAmenca 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 =Disposal By Lab Archive For Months <br /> Deliverable Requested:I,Il,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/OC Requirements: <br /> Empty Kit Relinquished b Date: Time: Method of Shipment: <br /> Relinquished by: Daterri aompany Received by: Daterrime: Company <br /> Relinquished by: Date(f Company Received by: Date/Time: Company <br /> fV <br /> O Relinquished by: DatelTime: Company ec 'v by: Date/Time: <br /> v <br /> y 6 <br /> Custody Seals Intact: IC2 S I ��� -^� (�� ` oerT M,_ re(s) Cand t7!emarks: <br /> Yes 4 No / ' C C <br /> e <br /> n <br />