Laserfiche WebLink
Eurof"sns TestAmerica,Pleasanton Chain of Custody Record I�I�Il� IIIII1ti`eurOfinS Environment Testing <br /> 1220 Quarry Lane <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM C77 T ckmg No(s)C, W COC No, <br /> Client Information (Sub Contract Lab) Gonzales,Justinn b (f 720-42030.1 <br /> Client Contact Phone' E-Malt- Slato of Origin Page <br /> Shipping/Receiving }ustinn.gonzales@testamericalno.com California Page 1 of 1 <br /> Company Accraditations Required(See note) Job# <br /> TestAmerica Laboratories,Inc State Program-Califofnla 720-92832-1 <br /> Address Due Date Requested: Preservation Codes: <br /> 17461 Dorian Ave, Suite 100, 511512019 Analysis Requested <br /> A•NCL M-Hexane <br /> City TAT Requested(days): `r t 13-NaOH N,None <br /> Irvine C-Zn Acetate 0-AsNa02 <br /> State.Zip 0 D-Nitric Acid P-Na204S <br /> CA,92614-5817 _ E-NaHSO4 0-Na2SO3 <br /> F-McOH R-Na2S203 <br /> Phone PO# c G-Amchlor S-H2SO4 <br /> < ro <br /> 949-261.1022(Tei) 949-260.3297{Fax} � � � H-AscarbkAcia T-TSPDodecahydrate <br /> Email WO lfa c v,' g S-Ice U-Acetone <br /> 'ri� m rJ } s J-DI Water v-MCRA <br /> Z K-EDTA W-pH 4-5 <br /> Project Name Project# O ��' L-EDA Z-other(specify) <br /> UPRR-Stockton Monthly&Semi Annual 72004592 ° a ry ta <br /> ta <br /> ;: • her: <br /> Site SSOW# m a v s rOt <br /> ' <br /> y <br /> Sample Matrix N ia <br /> 4t 3 <br /> (w'°�'erK, a C E tli H <br /> Type zE U,8=adM y� <br /> Sample (C=comp, <br /> Sample Identification-Client ID Lab ID Sam le Date Time G-grab) at-T,.—,Am 8 m 8 n 1,'' S vial lastrf�ettonslNote: <br /> (�D 540181 W#1(720-92832-1) 51- 09-30 <br /> 2119 Pacific water X X"'r X X? X X' 'X X " <br /> O <br /> EEE <br /> g. <br /> Note Since laboratory accreditatioris are subject to change.TestAmenca 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 /> currenVy main aln accreditation in the State of Origin listed above for analysisltesWmatnx being analyzed,the samples must be shipped back to the TestAmenca laboratory or other instructions writ be provided Any changes to accreditation status should be brought to TestAmeace <br /> Laboratories.Inc allenton immediately !f all requested accreditations are current to dale,return the signed Chain of Custody attesting to said compbcance to TestAmenca Laboratones,Inc <br /> Possible Hazard identification Sample Disposal(A fee may be assessed ff samples are retained longer than 1 month) <br /> Unconfirmed Return To Client Disposal By Lab Archive For Months <br /> Deliverable Requested:1,II,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/0C Requirements: <br /> mpty Kit elinquished by: Date- Time: Method of shipment <br /> Relinquished Datum -= Company Received by DateIrme Company <br /> �r <br /> Rehnq lied y Da e17 a Company Received by DatefTime, Company <br /> Ut <br /> ORehn is dby Date/Time Company i t Dat IT me S�� Com ny <br /> CD !l <br /> N Custo Seals Intact. Cnstody Sea[No.: co p tures)°C an Other Ramarka <br /> Yes A No 2 - L` z-tel" <br /> Ver:01!1612019 <br />