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TestAmerica Pleasanton Tes� menca <br /> 1220 Quarry Lane Chain of Custody Record sm <br /> Pleasanton, CA 94566 <br /> '}+r 1 rA)Fo .,fVV'RpNMrl Tkt TrST'riC <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler, Lab PM- Camer Tracking No(s)' COC No <br /> Client Information (Sub Contract Lab) smith,Micah 720-38082.6 <br /> Client Contact Phone E-Matl State drOngin. Page' <br /> Shipping/Receiving mlcah.smith@testamencainc.com California Page 6 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 Derain Ave, Suite 100, 4123/2018 Analysis Requested A-HCL M-Hexane <br /> City TAT Requested(days): B-Na0H N-None <br /> Irvine C-Zn Acetate O-AsNa02 <br /> State,Zip. D-Nitric Acid P-Na204S <br /> CA,92614-5817 �11 E-NaHSO4 D•Na2SO3 <br /> e•'�• F-Me0H R-Na2S203 <br /> Phone' PO# �R ' ° IS-Amchlor S-H2SO4 <br /> 949-261-1022(Tei) 949-260-3297(Fax) $ H-AscorbicAcld T-TSP DDdecahydrate <br /> 1-Ice U-Acetone <br /> Pacific <br /> Ema€I W D#. J-DI Water V-MCAA <br /> K-EDTA W-pH 4-5 <br /> Project Name Projed# Y = L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 o g <br /> Sate' SSOW#: 0 � Other: <br /> m <br /> Sample Matrix ] <br /> Type {w-.v€e.s..a to m$ 7C <br /> Sample (C=coma. o�.e eewr m $m <br /> Sam a Identification•Client ID Lab ID ca <br /> Sam le Date Time G= b eT=rw..�.a i'i "m ►- Special Instructions/Note: <br /> cn Ptesetvation t,ode: <br /> (D <br /> M-24C1(720-85830-46) 4/10118 14'04 Water X 3 <br /> O Pacific <br /> CD M-17C1(720-85830-47) 4110118 P4'2i Water X 3 <br /> 0 <br /> M-43D(720-85830-48)4110118 14.29 Water X 3 <br /> N <br /> Note-Since laboratory accreditation are subject to change,Test.4merica Laboratorsn,Inc places the ownership ai method,analyte B accreditation owphance upon out subcontract laboratories This sample shipment is Forwarded under chain-of-custody I <br /> Possible Hazard ldentiftation Sample Disposal(A fee may be assessed if samples are retained longer than i month) <br /> Unconfirmed I ©Return To Client ©Disposal By Lab �Archive For Months <br /> Deliverable Requested:I,It,Ili,N,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by: JDate, Time: Method of Shipment <br /> Relinquished by Daterri e' C ny Received by Dalerrime Company <br /> Relinquish y Dated Co pany Received by. Daterrime Company <br /> C71 0Re$mqurshed by DatefFtme' Company Receiver!by Co <br /> — <br /> N <br /> O Cus dy S Is Intact. Custody Seal No.: Cooler Temper d Other Remarks <br /> Dp Yes 4 No <br /> Ver-0912 012 0 1 6 <br /> n <br />