Laserfiche WebLink
TestAmerica Pleasanton Loc:720 ry �'y <br /> 1220 QuarryLane i fA l�'y'�1e 1c � CDCD <br /> Pleasanton, CA 94566 Chain of Custody Record 7$$45 <br /> CV <br /> Phone(925)484-1919 Fax(925)600-3002 enosrx rH evvaworrneeNrac resrrwG 00 <br /> Sampler: Lab PM: lo: <br /> Client Information (Sub Contract Lab) Sharma,Dimple ;3585.1 <br /> Client Contact: Phone: E-Mail: 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 /> 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-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> E-NalQ-Na2SO3 <br /> Phone: <br /> PO#: 2 F-McOH R-Na2S203 <br /> PhoG-Amchlor S-H2SO4 <br /> 615-726-0177(Tel) 615-726-3404(Fax) 0 "moo H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: Z Ox 'v I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> K-EDTA W-pH 4-5 <br /> Project Name: Project#: L-EDA Z-other(specify) <br /> UPRR-RetTank-Stockton 72012176 ; = 4 c <br /> Site: SSOW#: v _m 0 Other: <br /> A @ N <br /> y pp a o' <br /> a G <br /> Sample Matrix < E <br /> Type (w-w-, a z <br /> s=:ora, a <br /> Sample (C=comp, oa asrue;l, o a <br /> Sample Identification-Client ID Lab ID Sample Date Time G=grab) BT=Tssue,A=ar i, o �; Special Instructions/Note: to <br /> Preservation.Code: 4-- <br /> O <br /> 3670-TANK(720-78845-1) 4/10/17 12:45 Water X X 5 M <br /> Pacific <br /> N <br /> i� <br /> tts <br /> d <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 Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed I =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 /> r <br /> Empty Kit Relinquished by: Date: Time: Method of shipment: <br /> Relinquished by: - OatelTi e:. COTMany Rec'v by: Date/Time: Compan <br /> '- �°_'� �� C � � �• �. � tZ�ld 1 is .� <br /> Relinquished by: DateTme: Company Re v y: Datefrime: Company <br /> Relinquished by: Date/Time: Company Received by: Date/Time: Company <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)OC and Other Remarks: <br /> A Yes A No <br />