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El <br /> TestAmerica Pleasanton Loc:720 �y►� ./+��y <br /> 1220 Quarry Lane QQ st 1 ( { Ira CD <br /> Pleasanton, CA 94566 Chain of Custody Record 7$$�4 N <br /> Phone(925)484-1919 Fax(925)600-3D02 ADER IN ENVIRONMENTAL TESTING \ <br /> a7 <br /> Sampler: Lab PM: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 585.1 <br /> Client Contact: Phone: E-Mail: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Canton". 1 of 1 <br /> Company: Accreditation,Required(See note): Job#: <br /> TestAmerica Laboratories,Inc State Program-California 720-78844-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2960 Foster Creighton Drive, 4/17/2017 Analysis Requested A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Nashville C-Zn Acetate 0-A,NaO2 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> TN,37204 E-NaHSO4 Q-Na2SO3 <br /> in F-MeOH R-Na2S203 <br /> Phone: PO#: G-Amchlor S-H2SO4 <br /> 615-726-0177(Tel) 615-726-3404(Fax) Or a H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: Z o '& I-Ice U-Acetone <br /> "o' F -2 N J-Dl Water V-MCRA <br /> y w x` `v K-EDTA W-pH 4-5 <br /> Project Name: Project#: y v -o c. <br /> UPRR-RetTank-Stockton 72012176 d _ L-EDA Z-other(specify) <br /> Site: SSOW#: v mom;Other: <br /> IL <br /> y c IA <br /> Sample Matrix 2 <br /> Type (W-- t., - F z <br /> S—Iid, eJ <br /> Sample (C=comp, 0. ,0;,, a m a a <br /> Sample Identification-Client ID Lab ID Sample Date Time G=grab) BT=Tissue,A=Air u oF° Special Instructions/Note: L0 <br /> Preservation Code: O <br /> 3776-TANK(720-78844-1) 4/10/17 11:20 Water X X t5 CD <br /> N <br /> 0) <br /> (0 <br /> d <br /> Note:Since laboratory accreditations 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 analysisltests/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. [fail requested accredrations are current to date,retum the signed Chain of Custody attesting to said complicance to TestAmerica Laboratories,Inc. <br /> Possible Hazard IdentiPication Sample Disposal(A fee may be assessed if samples are retained longer than 9 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=Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of shipment: <br /> Relinquished by: Daterfi any Receivedi Date/Time: Company <br /> Relinquished by: Daterrime: Company �' Rec'e y: Dateriime: Company <br /> Relinquished by: Date/Time: Company Received by: DaterTime: Company <br /> Custody Seals Intact: Custody Seal NO.: Cooler Temperature(s)°C and Other Remarks: <br /> A Yes A No <br />