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Te <br /> stAnner <br /> 122nyLane Pleasanton p pppIpI i,I !pH N7 tlpp Tesfi menea <br /> Pleasanton. CA 94566 �- Y �G, % Chain of Custody Record III�II IiBIIIIIIIIIUIIiII!II�uIIIIIIIIInA�a <br /> Phone(925)484-1919 Fox(925)60D-3002 <br /> tile:LEAOFR III FNYmONYFMIaL ll"JnNQ <br /> Samploc. Lab.PM: king Nola): COCNo: <br /> Cartla Trac <br /> Client Information (Sub Contract lab) Duongi Paloma R 72031057.1 <br /> Client Ccntacc Mom: E-Mall: Slake of Origin: Page: j <br /> Shlpping/Recelving paloma.duong@leslamencalnacom califomia Page 1 of 1 <br /> Company AWeqdNbm Required(Sae ran): Jobe: <br /> TeslAmenca Laboratories,Inc. NELAP-California;Slate Program-California 720-75604-1 j <br /> Address: Due Dab Requaebd: Preservation Codes: <br /> 4101 Shuoal Street NW, 11/412016 Analysis Requested A-HCL M-hle[ano <br /> CII, TATRICUNded(days): <br /> Nath Canton B-NaOH N.Nona <br /> C-Zn Aceble O-AEW02 <br /> Slate.La:' - 0-1,1IVIc AGd P-14a204S <br /> OH,44720 E-NDHSO4 0-W2soo <br /> Phone PON: _ P-MeOH R-W2S203 <br /> G-Arilchbr S-H2SO4 <br /> 330-097-9396(Tel) 330-097-0772(Fax) o % H-Araxwbl[Actl T-TSP Dardecanydrao <br /> Email: - WON M u I-lost u-Aadpne <br /> J-01 Water V-MM <br /> K-EDTA W-pH e.5 <br /> Plelod Wmo: Pmlad e; = `a n 9' L-EDA Z-obs lsncdly) <br /> MCContlald le:antl Production Tank,McDond 72009842 . S o c <br /> Ste: DISOWN: E G u okher. <br /> In N dF e O <br /> a dI x <br /> semplo McMx <br /> Sample (CTcomV. me.,..aYvu, 11 t° C 3 <br /> Sample Identification-Client ID Lab ID Sam Ie Data Time G=grab) aI.iu.u,a.N, 4 'ori N a° r r Special lnstruclionsiNote: <br /> M PreservaBon Code: <br /> N WHISKEY SLOUGH-TANKIX D-2 720-7.5504-1 13:05 <br /> N ( ) 10/28/16 P r Water X X 1 <br /> W <br /> O <br /> N <br /> V <br /> Nde DIm[e laboratory xvodlblldne aro stub rot l0 cnango.TodNmalSa Labaalodall.Inc.pledoc gle w'm1aMp ar memod.:Nlalylq 6 awWllplbn cEnmllpnco upgn auk eubmnlrad lahoralodes.This Sample ehlpmanl Is forwarded under chair!eusbdy. Ir Ind IroaalLry daa9 not <br /> currentlymolnuln acvodlMon M IM Slate of olgin listed above for analyslagrsRlmabla being analyzed,Ilio oY11Wes must be enticed back b the TaeWnalca Inbvalay a other Instructions will be provided.Any changes to accruddaYan SMWS should be bmoghl In TepAmerica <br /> Laaaalallea.Inc,paeiMn Immediately.If dl requested oro nedibibns are curlanl to dela,realm tire signed Chain of Custody allaslktg to said campl Eanca to T6aMn1a1W Laboralales,Inc. <br /> Possible Hazard larentiffcatlnn Sample Disposal(A fee maybe ass it//samples areretained longer than 1 month) <br /> Uncenfrrned MRetum To Client [ Ds Sal By <br /> Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV,Other(spec,IV) Primary Deliverable Rank:2 Special Instructions/OC Requirements: <br /> Empty Kit Relinquished by: Date: Time: Mobmd al Shlanml: <br /> Reamtdsheaby. Dations"y! Camp Rec d. Oa OZ & Contrary. <br /> it <br /> Rehnqubned by Od Tim' Company Mina OaIMImu Company <br /> fJ <br /> p Rellnquencd by Dreanlmal Contrary Recal by. palel(Imu: Company <br /> ID) <br /> CustodysealslmaeC Custody Seal No.: Coda Temperature(.)°CawOtherRemado- <br /> A Yes A filo <br />