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TestAmerica Qmeraca Pleasanton VIII IIII IIIIIII IIIc lllillllllll llllillllllllllll TestAmerica <br /> Pleasanton, CA 94566 Chain of Custody Record <br /> THE LFADFR IN ENVIRONMENTAL TFSTMG <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 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, 4/14/2017 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: <br /> D-Nitric Acid P-Na204S <br /> CA,92614-5817 E-NaHSO4 Q-Na2SO3 <br /> F-MCOH R-Na2S203 <br /> Phone: PO#: <br /> ' G-Amchlor S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) p H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: Z - ' I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> Z. <br /> Project Name: Project#: �' - K-EDTA W•pH 4.5 <br /> O L-EDA Z-other(specify) <br /> UPRR-Ret Tank-Stockton 72012176 m <br /> Site: SSOW#: _ Other: <br /> Sam le Matrix wl a w <br /> P E <br /> Type (w waren, of Z z <br /> 5-solid V <br /> Sample (C=comp, o_„-„e/oil, 2 �q o d <br /> Sam le Identification-Client ID Lab ID Sample Date Time G=grab) aT-Tis ,A-Ar. IL ca r I- Special Instructions/Note: <br /> N Preservation Code: <br /> ( 3670-TANK(720-78845-1) 4/10/17 pa 12:45 Water X X X X "5.. <br /> v <br /> ficO <br /> rs <br /> N <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 Identiflication 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,II,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements: <br /> Empty Kit Relinquish d y: IDate: Time: Method of Shipment <br /> Relinquished by: Date/Ti ,,,! Com2&wr7 Received by: Datelfime: Company <br /> r <br /> 00 Relinquished by: - D Ri Company Received by: Date/Time: Company <br /> N <br /> CD Relinquished by: Date/Time: Company eiv d Date/Ti <br /> CUSt Seals Intact: Cus d Sea N .: , Y12 7 �7 ,.� Co er �rature(s) Cand C I er Remarks: <br /> Yes 4 No <br /> 1�'.� l' <br />