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TestAmerica Pleasanton Testmerie� <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> -rir i rnorp 5v rvi.,antivrNrnI rrsr=hG <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM Camey Tracking No(s), COC Nc <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38082.4 <br /> Client Contact. Phone E-Mail• State of Origin Page' <br /> Shipping/Recetving micah.smith@testamencalne.com California Page 4 of 6 <br /> Company Accreditations 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): B-NaOH N-None <br /> Irvine N`' C-Zn Acetate 0-AsNa02 <br /> State,Zip ,' '• D-Nitric Acid P-Na204S <br /> CA,92614.5817E-NaHSO4 Q-Na2503 <br /> • E F-McQH R-N925203 <br /> Phone- PO# ° G-Amcmor S-H2504 <br /> 949-261-1022(Tel) 949-260-3297(Fax) pal'"i a H-Ascorbic Acid T-TSP Dodecahydrate <br /> +� , A I-Ice U-Acetone <br /> £malf- WO# tit g J-DI Water V-MCAA <br /> Protect Name* Project# • r K-EDTA W-pH 45 <br /> Nestle-Ripon 72000256 a x L-EDA Z-other(specify) <br /> ,o <br /> Site SSOW# r Other: <br /> SampleE <br /> Matrix m <br /> Type s. <br /> Sample (C=comp, o-.we A. g m <br /> _113 Sam le Identification-Client 1D Lab ID Sample Date Time G= rib) a`T.rr., A-w, u 2 ro t- Special Instructions/Note: <br /> � 'Pleservatityvt Code:' <br /> CD <br /> M-27A(720-85830-28) 4110118 09'Pacf3 Water X 3 <br /> 00 09:53 <br /> 0 M-27A DUP(720.85830-29) 4/1011810 Water X 3 <br /> Pac <br /> M-27C(720-85830-30) 4110118 10.03 Water X 3, <br /> PacificN <br /> M-27D(720-85830-31) 4110/18 10:10P afi Water X 3 <br /> M-28A(720-85830-32) 4110/18 10:31 Water X 3 <br /> F Pacific <br /> M-28C(720-85830-33) 4110118 10.43 Water XPacific <br /> 3 <br /> M-28C1(720-85830-34) 4110118 10'49 Water X 3 <br /> Pacific <br /> M-29C1(720-85830-35) 4110118 11'07 Water X .3 <br /> P aft <br /> M-29C2(720-85830-36) 4110/18 11'14 Water X 3 <br /> Pacific <br /> - - - I <br /> Note Since laboratory accredltations are subject to change,TestAmenca Laboratories,Inc places the ownership of method,analyte d accreditation compliance upon out subcontract laboratories This sample shipment is forwarded under ohain-of-custody.r <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed Return To Client ©D1sposat By Lab Archive For Months <br /> Deliverable Requested:1,ll,III,IV,Other(specify) Primary Deliverable Rank-2 Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by: Date. Time: Method of Shipment. <br /> Relinquished by Dat/Time mpany Received by' Datemme, Company <br /> Relinquished by latemm. Company Received by DgT 7 " C ny �� <br /> _P1iU F�I� <br /> N Relinquished by Datefrime. Company Received by Oaterillme. Company <br /> N <br /> C:) CustoOMVIs Intact. Custody Seal No., Cooler Temperature(s) -marks <br /> 0p d es 4 No <br /> Ver-0912 0120 1 6 <br /> n <br />