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TestAmerica Pleasanton TestAmerica <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> THF E rxorR 11 FVVI4CrrvNFti TAt LF$T`PG <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM. Carrier Tracking No(s) COC No, <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38082.3 <br /> Chant Contact Phone E-Mall State of Origin, Page. <br /> ShippinglReceiving m€cah.smith@testamencamc corn lCalifornia Page 3 of 6 <br /> Company' Accreddabons Required(See note) Job# <br /> TestAmerica Laboratories,Inc NELAP-California;State Program-Cal€€omia 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): B-NaOH N-None <br /> Irvine C-Zn Acetate O-AsNa02 <br /> •"�; D�Nitric Acid P-Na204S <br /> State,Zip ' ' E-NaHSO4 0-Na2SO3 <br /> CA,92614-5817 ; ti F-M90H R-Na2S203 <br /> Phone: PO# � G-Amchlor S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) V H-Ascorbic Aad T-TSP Dodecahydrate <br /> i3 A l-" U-Acetone <br /> Email WO# G J-Dl Water V-MCAA <br /> �€ g, K-EDTA W-pH4-5 <br /> Protect Name Prof#' = L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 .2 g <br /> Site SSOW#: ° Ottser. <br /> s <br /> m � <br /> Sample Matrix ]m <br /> Type {w-. 's-s<aw U- <br /> m <br /> Sample (C=comp, I , m <br /> Sam le ldentifisation-Client 1D Lab 1D Sam le Date Time G- rab eT-T—,AMk m 1 1 1 Special Instructions/Note: <br /> hresettiSfiDh Code: <br /> CD M-49A(720-85830-19) 419/18 Pacific <br /> Water X 3 <br /> v 15:56 <br /> o M-10A(720-85830-20) 419118 if Water X 3 <br /> PacO M-10B(720-85830-21) 419/18 16'04 Water X 3 <br /> N Pacific <br /> M-10C1(720-85830-22) 4/9118 P6 1 1 Water X 3 <br /> M-13A(720-85830-23) 419118 P16:23 Water X 3 <br /> acc <br /> M-136(720-85830-24) 419118 1628 Water X 3 <br /> P rfl <br /> M-40D(720-85830-25) 419118 16.36 Water X 3 <br /> Pacific <br /> M-55A(720-85830.26) 4/9/18 16:44 Watefic r X 3 <br /> WB-041018(720-85830-27) 4110118 09'43 Water X 3 <br /> —Pac <br /> Ll I I — I I + <br /> Note Since laboratory accred€tatrons are subject to change,TestAmerica Laboratories.Inc places the ownership of method,analyte 8 accreditation compliance upon out suboontraetlaboratones This sample shipment is forwarded under than-of-custody I <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,ll,ill,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements <br /> Empty Kit Relinquished by: Date: Time: Method of shipment <br /> Relinquished by f DateMme, many Received by Dale/rime: Company <br /> — r <br /> Relinquished by Dat sine. mpany Received by Date/rime' Company <br /> N Relinquished by Daterr'Ime Company Received by e € Q 7 r� Cty�Q�y� /"jii <br /> Ik lj <br /> N <br /> O custoofSels Intact. Custody Seal No.: Cooler Tompefature(s) r Remarks: <br /> 00 ©ftes JA No <br /> Ver OW20/2016 <br /> e nn F <br /> n <br />