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TestAmerica Pleasanton Chain of Custody RecordTest medca <br /> 1220 Quarry Lane <br /> Pleasanton, CA 94566 <br /> 1Hr i FAaE­ns rww1a0raM[117A: rr^Ttr:G <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 720-33572.1 <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 /> TestAmerica Laboratories,Inc State Program-California 720-78845-1 <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): 't;; 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 Q-Na2SO3 <br /> Phone: PO#: F-McOH R-Na2S203 <br /> • G-Amchlor S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: I-Ice U-Acetone <br /> J•DI Water V-MCAA <br /> Project Name: Project#: a Lzg K-EDTA W-pH 4-5 <br /> UPRR-Ret Tank-Stockton 72012176 d L-EDA z-other(specify) <br /> 0 <br /> Site: SSOW#: m Other: <br /> Sample Matrix 0 <br /> mi 7 <br /> Type <br /> Sample (C=comp, o-wes-.meu.w, <br /> Sample Identification-Client ID Lab ID Sample Date Time G=grab BT:Tiuue,A+Afr iii` u�i 1�,' Special Instructions/Note: <br /> a) preservation Code: <br /> ( 3670-TANK(720-78845-1) 4/10/17 12:5 Water XPacififi <br /> O <br /> crlN <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 track to the TestAmenca 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 accreditation are current to date,return the signed Chain of Custody attesting to said complicance to TestAmerica Laboratories,Inc. <br /> Possible Hazard/dentifcationSample 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:1,If,lit,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of shipment: ' 4 <br /> Relinquished by J DatelTime: G any Received by ,� DatelTim _ Company <br /> �V ��-� .3« riW ) <br /> Z Relinquished by: Date/Time: Company Received by Date rime: Company <br /> N Relinquished by Date/Time: Company Received by DateMme: Company <br /> O_ <br /> v Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks <br /> A Yes A No 62 t` <br /> e � 1 -11-1 <br /> n n <br />