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zestA eri a Pleasanton TestA1'�r edc a <br /> Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> *lir i rn!)ra Iti'•vviaonNrvrni Tr';r«:c <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler* Lab PIN Carver Tinq Tip(s],. �� COC No- <br /> Client Information (Sub Contract Lab) Smith,Micah ZZ�GI 720-38082.1 <br /> Client Contact, Phone E-Mail- State of Ongin: Page. <br /> Shipping/Receiving micah.smlth@testamericalnc.com California Page 1 of 6 <br /> Company Accreditabons Required(See note) Jub# <br /> TestAmerica Laboratories,Inc NELAP-California:State Program-California 720-85830-1 <br /> Address Due Date Requested: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 4/23/2018 Analysis Requested A.HCL M-Hexane <br /> City TAT Requested(days): a, B-NaOH N-None <br /> Irvine a C-Zn Acetate 0-AsNa02 <br /> State,Zip 3 D-Nitric Acid P.Na204S <br /> CA,92614-5817 a E-NaHSO4 4-Na2SO3 <br /> 4 F-MeOH R-Na2S203 <br /> Phone PO#. 0 G•Amchlor S-H2SO4 <br /> 949-261,1022(Tei) 949-260-3297(Fax) p 2 H•AscorbcAcid T-TSPDodecahydrate <br /> Email WO#- Z i-lee U-Acetone <br /> J-DI Water V-MCAA <br /> K-EDTA W-pH 4S <br /> Protect Name Protect#. = <br /> Nestle-Ripon 72000256 L-EDA 7-other(specify) <br /> Site SSOW# Other: <br /> m � <br /> Sample Matrix <br /> Type (W—.-,s--id is <br /> Sample (C=comp, o-. hdwi. 32 <br /> m <br /> Sa=te Identification-Client!D(Lab JIDI Sampit Date Time G- rab 9s.narw.,Mra m m w S eclat tnstructtonslNote: <br /> cQ p�seivabvn <br /> Pacific <br /> CD TB-040918(720-85830-1) 419118 08:45 Water X 2 <br /> <n 09:28 <br /> O M-12A(720=85830-2) 4!9118 WaterX 3 <br /> Pacific <br /> M-47A(720-85830-3) 09118 P10,00 Water X 9 <br /> N 10:00 <br /> M-47A DUP(720-85830-4) 4/9118 PacificWater X 3 <br /> M-25C1(720-85830-5) 419118 10-09 Water XPacific <br /> $ <br /> M-2502(720-85830-6) 419118 10:17 Water X 3, <br /> Pacif <br /> EW-1(720-85830-7) 4/9118 10:2Pag8 <br /> Water X 3- <br /> M-lA(720-85830-8) 09118 10-33 Water XPacific <br /> 3 <br /> M-1B(720-85830-9) 419118 10-38 Water X 3 <br /> f Pacific <br /> Note,Since laboratory aCCredlabOnS are subject to change,Tesipmenca Laboratories,Inc places the owners;Np of method,analyte&accreditation compliance upon out subcontract laboratories. This sample shipment is forwarded under cham-0f-custody H the laboratory does not <br /> currently maintain accreditation in the State of Origin listed above for analysialtestslmatrix being analyzed,the samples must be shipped back to the TestAmenca laboratory or other instructions will be provided Any changes to accreditation status should be broughtto TestAmenca <br /> Laboratories,InC attantion immediately If aH requested accreditabons are current to date,return the signed Chain of Custody attesting to said complicance to TestAmenca Laboratories,Inc. <br /> Possible Hazard identification 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,f,11,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/0C Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of Shipment <br /> Relinquished b Date/Time an Recewed by Datenime Company <br /> Relinquished by Daterrime ComAny Received by. DatefTime Company <br /> \ q DatelTime Company Received by O �rri�. qqo C01"Ay�W <br /> � Relinquished by II (J`ik [f l"C <br /> D CUS d S is Intact: Custody Seal No.: cccier Temperatures° ther Remarks 1 r,�n 4-(jf <br /> Go IF 4 Yes A No t 'T U lY <br /> Ver.09/20/2016 <br /> e <br /> nnF-1 F-1 <br />