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TestAmerlca Pleasanton Chain of Custody Record INTI NNIIINI�II�IN I� IIIIIINIINIIINIII Test meka <br /> 1220 Quarry Lane <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 -irr t rAnraW—vm(,NmrN7A; Trsnr.c <br /> Sampler Lab PM: Qarner Tr kin s)�� COC No, <br /> Client Information (Sub Contract tab) Smith,Micah X99 '{1 720-38136.1 <br /> Chest Contact Phone E-Mail State of Ongin: Page <br /> Shipping/Receiving micah.smith@testamencalnc com California Page 1 of 4 <br /> Company Accreddations Required(See note) Job#. <br /> TestAmenca Laboratories,Inc NELAP-California,State Program-California 720-85891-1 <br /> Address Due Data Requested: Preservation Codes: <br /> 17461 Darien Ave, Suite 100, 4125/2018 Analysis Requested A,HCL M-Hexane <br /> City TAT Requested(days): �'y e, B-NaOH N-None <br /> IrVFtte `" C-Zn Acetate 0-AsNa02 <br /> State Zipa <br /> tih ° D-Nitric Acid P-Na2048 <br /> CA,92614-5817 S E-NaHSO4 0-Na2SO3 <br /> Phone PO# F-MeOH R-Na2S203 <br /> �: <br /> hlor <br /> 949-261-1022(Tel) 949-260-3297(Fax) w H-Asc-Acoorbicbic s-H25o4 <br /> ' � g Acid T-TSPDotlecahydrate <br /> Email WO# P�" C I-Ice U-Acetone <br /> J-Dr Water V-MCAA <br /> Project Name Project# m K-EDTA W-pH 4.5 <br /> Nestle-Ripon 72000256 * L-EDA Z-other(specify) <br /> 3 0 <br /> Site, 3SOW#: Omer: <br /> e <br /> Sample <br /> Matrix to <br /> Type rL I N z <br /> Sample (C=coma, <br /> Sample Identification-Client ID Lab ID Sam le Date Time G=grab) in-rte.,A.ra f m m Special Instructions/Note- <br /> � isfeservatlotl Cotte: . <br /> N <br /> 08:172 <br /> CD TB-041218(720-85891 1) 4/12118 Water X L ttt3-t4 <br /> Pacific <br /> Cn M-21C1(720-85891-2) 4/12118 P11.01 Water X 3 <br /> j M-21D(720-85891-3) 11:15 <br /> 5891-3) 4112118 P tf1 Water X 3 <br /> M-21D DUP(720-85691-4) 4/12/18 P11:15 Water X 3 <br /> M-41A(720-85891-5) 4/12118 11.33 Water X 3 <br /> Pacific <br /> M-41C(720-65891-6) 4112/18 11.40 Water X 3 <br /> Pacific <br /> M-41D(720-65891-7) 4112118 1147 Water X 3 <br /> i <br /> M-23A(720-85891-8) 4112118 11.58 WaterX 3 <br /> Pacific <br /> M-23D(720-85891-9) 4112118 1 11 <br /> 2" 5 1 Water X 3 <br /> Note.Since laboratory accreditabons are subject to change,TestAmerics Laboratones,Inc places the ownership of method,analyte&accreditation compliance upon out subcontract laboratories, The sample shipment Is forwarded undercham-ofcustody If the laboratory does not <br /> currently maintain accreditation in the State of digin listed above for analysisltesls/matnx being analyzed,the samples must be shipped back to the TestAmenca aboratory or other instructions wdl be provided Any changes to accreditation status should be brought to TesL4menca <br /> Laboratories,Inc attenbon immediately If all requested accreditation are current to date,return the signed Cham of Custody attesting to said comphcance to TestAmedca Laboratories,Inc , <br /> Possible Hazard ldendrrcation Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed ©Return To Client ©Disposal By Lab Archive For Months <br /> Deliverable Requested:I,11,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions=Requiremants: <br /> Empty Kit Relinquished by. Date: Time: Method or Shipment <br /> Relinquished by Dat i e: //�'//�� Coop e <br /> ny Received by DatpMme• Company <br /> Relinquished by Date me. Company Received by DaterTme• Company <br /> f j Relinquished by Date/Time Company Received by Da€ i <br /> gi _ 4 .1 <br /> O Cu8t y eals Intact: Custody Seal No: Cooler Tempera er Remarks <br /> A Yes A No <br /> 00 Ver,09/20/2016 <br /> n <br />