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TestAmerica Pleasanton Tj=1z ee <br /> 1220 Quarry Lane Chain of Custody Record MR <br /> Pleasanton, CA 94566 <br /> 'Iii SFl1"•"r N�Vu'In CN Mf 4TA' Tf 5T•r,C <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM Canner Tracking No(s) COC No <br /> Client Information (Sub Contract Lab) smith,Micah 720-38136.2 <br /> Chent Contact, Phone E-Mad State of Origin Page <br /> Shipping/Receiving mlcah.smith@testamericainc.com Caldornla Page 2 of 4 <br /> Company Accreddabons Required{See note)' Job#: <br /> TestAmertca Lahnratorles,Inc NELAP-California;State Program-Califomia :720-85891-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 4/25/2018 Analysis Requested A-HCL M-Hexane <br /> Gty: TAT Requested(days): B-NaOH N-None <br /> Irvine ;, "' C-Zn Acetals 0-AsNa02 <br /> r <br /> Zip: D-NdncA.cld P-Na204S E-NaHSO4 0-Na2SO3 <br /> State, �'�ti�� � <br /> 4" $ <br /> GA,92614-5$17 Vii'"-� <br /> !''„ F-M&ON R-Na2S203 <br /> Phone, # "(a G-Amchlor S-H2SO4 <br /> 949-261-1022{Tel} 949-260-3297(Fax) m H-Aswrbic Acid T-TSP Dodecahydrate <br /> Email WO# � I-Ice U-Acetone <br /> • J-DI Water V-MCAA <br /> 1 K-EDTA W-pH 4-5 <br /> Project Name, Project# L-EDA Z-other(specify) <br /> Nestle-Ripon 72000266 A o <br /> Site SSOW#: 0 Oilier: <br /> l m <br /> Sample Matrix <br /> m <br /> Type <br /> Sample (C=comp, ( o-...,wwr, m 2 <br /> Sam fe Identification-Client ID Lab ID Sample Date Time G=grab) ar.Tw_,MAI a m m Special Instructions/Note: <br /> U Presoy soon Code. <br /> N <br /> TH-7(720-85891-10) 4112118 UX Water X 3 <br /> P Ill <br /> 0-) TH-8(720-85891-11) 4112118 14' 3 Water X $, <br /> M-20C1(720-85891-12) 4112118 1453 Water X 3 <br /> acific <br /> M-20D(720-85891-13) 4112118 14.5 Water X 3 <br /> M-3101(720-85891-14) 4112/18 15:18 Water X 1 3 <br /> acific <br /> M-31,31 DUP(720-85891-15) 4112118 15:18 Water X 3 <br /> M-31C20(720-85891-16) 4112118 15`25 Water X 3 <br /> Pacific <br /> 15:M-33C(720-85891-17) 4112118 acWater Ix Pifi ifiTH-9(720-85891-18) 4/12118 16:01 Water 3 <br /> P rfi <br /> Note Since laboratory accreditabons are subject to change,TestAmenca Laboratories,Inc.places the ownership of method,analyte&aeoteditabon compliance upon out subcontract laboratories This samp3e shipment is forwarded under chars-ofcusiody I <br /> Possible Hazard Identirrcation 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,II,llf,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/4C Requirements <br /> Empty Kit Relinquished by: Date: Time- method of Shipment <br /> Relinquished by Dat tri ( Received by. Datel7 ime Company <br /> Reh quished by Lima#I ime Company Received by DateTime Company <br /> Relinquished by. DatelTime Company Received by Da i ComRapye��r^ <br /> N !L,-y'If <br /> N <br /> O Cus eats Intact: Custody Seal No., Cooler Temperatur ar smarks <br /> Co AkYesj e No <br /> Ver:09/20/2016 <br />