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TestAmerica Pleasanton Tes} ��� <br /> 1220 Quarry Lane Chain of Custody Record I <br /> Pleasanton, CA 94566 <br /> -4rF tF0.PC4 fN FNV1R0vrIFM7A6 Tr$TIk C: <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM Garner Tracking No(s) COC No, <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38082.5 <br /> Client Contact, Phone E•Mai! State of Ongm Page <br /> Shipping/Receiving micah.smith@testamencalnc.com icallfornia Page 5 of 6 <br /> Company Accreddatxms Required(See nate) Job# <br /> TestAmenca Laboratories,Inc NELAP-California;State Program-California 720-85830-1 <br /> Address, Due Date Requested: Preservation Codes: <br /> 17461 Derian Ave, Surte 100, 4/23/2018 Analysis Requested A-HCL M-Hexane <br /> City TAT Requested(days) B-NaOH N-None <br /> Irvineyi4i C-Zn Acetate O-Asi <br /> State,Zip' ,`tti' D-Nitm Acid P-Na2O45 <br /> CA,92614-5817 `) E-NBHSO4 O-Na2SO3 <br /> E F-MeOH R-Na2S203 <br /> Pnwte PO G-Amchior S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) pp i v H-Ascorbic Acid T-TSPDodecahydrate <br /> Email WO# Z , ' `0 I-tee U.Acetone <br /> e <br /> a3 mmo J-DI W a[er V•MCAA <br /> K EDTA W-pH 4-5 <br /> Project Name: Protect# • <br /> x L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 <br /> Site, SSOW#• Other: <br /> w <br /> Sample Matrix <br /> J m <br /> Type `,; <br /> Sample (C=coma, �a,� m <br /> Sample Identification-Client lD Lab ID) sample Date Time G= rab eT.T, .,A-Nr Km Special InstructtonslNot®: <br /> sv PreviirVation Code- <br /> CD Nl-56A(720-85830-37) 4/10/18 11:30 <br /> CDPto <br /> Water X .1 <br /> 11'36 <br /> p M-57A(720-85830-38) 4110/18P .f. Water X 3 <br /> M-22A(720-85830-39) 4110118 11'52 Water X 3 <br /> N <br /> Pacific <br /> M-54C(720-85830-40) 4110118 114 Water X 3 <br /> Pacific <br /> M-54C DUP(720-85830-41) 4110118 13:14 Water X 3 <br /> acific <br /> M-14A(720-85830-42) 4110118 13'25 Water X 3. <br /> Pacific <br /> M-9A(720-85830-43) 4110118 1135 Water X 3 <br /> M-18A(720-85830-44) 4110118 13.45 Water Xacific <br /> 3' <br /> W18C1(720-85830-45) 4110118 1 13.51 <br /> Water X 3 <br /> Note Since laboratory accretlitai,ons are subject to change,TestAmenca Laboratories,Inc.places the ownership of method,analyte&accreditation compliance upon out subcontract laboratories.This sample shipment is forwarded under chain•of-custody I <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed Ifsamples are retained longer than 1 month) <br /> Unconfirmed I =Return To Client Disposal By Lab �Archrve For Months <br /> Deliverable Requested:I,II,lll,IV,Other(specify) Primary Deliverable Rank:2 Special InstructionsIOC Requirements: <br /> Empty Kit Relinquished by: Date: ITime: Method of Shipment, <br /> Relinquished by. I , DaITlme. G any Received by Datefrime Company <br /> l( Cie) <br /> Relinquished by Date Mme- ompany Received by D e a ( `07W— <br /> Relinquished <br /> om —Relinquished by Date/Time Company Received by. Dat me Company <br /> N <br /> C:) CU UySeals Intact: Custody Seai No.- cooler Temparature(s)°C and Other Remarks- <br /> Co Yes d No <br /> Ver.0 912012 0 1 6 <br /> � � <br />