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TestAmerica Pleasanton Testmenca <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 -{r rn�ra n rvv ram rvrvrns'fs °r <br /> Sampler: Lab PM Carrier Tracking No(s}, COC No: <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38082.2 <br /> Client Contact Phone E-Mail State of Ongln. Page: <br /> Shipping/Receiving Imill smllh@testamericaine.com California Page 2 of 6 <br /> Company Accreddabons Required(See note) Job#. <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): U B-NaOH N-None <br /> Irvine C-Zn Acetate 0-AsNe02 <br /> State,Zip: 'i}`,� `; D-Ndnc Acid P.Na2048 <br /> CA,92614-5817 ;} E E-NaHSO4 Q-Na2SO3 <br /> Phone PO# F-McOH R-Na2s203 <br /> kv U G-Amchlor S-H2504 <br /> 949-261-1022(Tel) 949-260-3297(Fax) nx, H-AscorbicAcd T-TSP Dodeeshydrate <br /> Z w <br /> Email WO#. � � [-ice U-Acetone <br /> • J-DI water V-MCAA <br /> Protect Name: Project#: K-EDTA W-pH 45 <br /> Nestle-Ripon 72000256 i,. Other; z-alher(specdy) <br /> Site SSOW# Other: <br /> o <br /> Sample Matrix ]m <br /> J <br /> Type (wawerm,9•.wM m w Z <br /> Sample (C=comp, o•.n am, <br /> Same Identification-Client iiaLab ID) Sample Date Time G= rab eT=Tsw.,MAO W. ' m Special Instructions/Note: <br /> v 138N$t4Dn Code-' <br /> M-48A(720-85830-10) 419/18 10:5 Water X 3 <br /> CD M-51A(720-85830-11) 419118 11 14 <br /> 0 Water X 3 <br /> O <br /> OPacifig— <br /> M-50A(720-85830-12) 4/9118 11.85 Water X 3 <br /> N <br /> M-iiA(720-85830-13) 419118 15:04 Water X 3 <br /> Pacific <br /> M-66(720-85830-14) 419118 15'10 Water XPacifi3 <br /> M-1313(720-85830-15) 4/9/18 15.18 Water X 3 <br /> acific <br /> M-613 DUP(720-85830-16) 419/18 15:18 Water Xacific <br /> 3 <br /> M-6C2(720-85830-17) 4/9118 15'28 Water X 3 <br /> M-6C1(720-85830-18) 419/18 15'36 Water X 3 <br /> Pacific <br /> Note Since laboratory accreditation are subject to change.TestAmenca Laboratories,Inc places the awnershlp of method,analyte B accreditation compliance upon out subcontract laboratones This sample shipment is forwarded under chain-0f-custody 1 <br /> Possible Hazard Identification Sample Disposal f A fee may be assessed if samples are retained longer than 9 month) <br /> Unconfirmed =Retum To Client ©Disposal By Lab ©Archive For Months <br /> Deliverable Requested.I,Il,111,IV,Other(specify) Primary Deliverable Rank:2 Special InstructionslOC Requirements: <br /> Empty Kit Relinquished by: Date' Time. Method of shipment <br /> Relinquished by Datemme Go a Received by. Date/Time Company <br /> wvi, (_, ) <br /> Relinquished by DateMmer Cclhri Received by Oate/Time. Company <br /> Relmquished by Daterrini Company Received by D�t�T p; ,(y /t!A Com-_ <br /> N 6I! L �} L G r <br /> O Cust Is Intact: Custody Seal No.: Cooler Tempera er Remarks. <br /> 00 Yes No <br /> Ver:09/20/2016 <br /> e nn F <br /> n <br />