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TestAmerica Pleasanton �S� ����.� <br /> 1220 Quarry Lane Chain of Custody Record 1 T <br /> Pleasanton, CA94566 <br /> -+r�ranra 3r,rvvir'oravt=vTn: *re>n:c, <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler. Lab PM. Carver Tracking No(s)' COC No, <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38136.3 <br /> Client Contact Phone E-Mail, State of Origin Page <br /> Shipping/Receiving micah.smith@teetamencainc.com icallfonma Page 3 of 4 <br /> Company Accreddations Required(See note): Job#' <br /> TestAmerica Laboratories,Inc NELAP-California;State Program-California 720-85891-1 <br /> Address Due Date Requested: Preservation Codes: <br /> 17461 Dorian Ave, Suite 100, 4/25/2018 Analysis Requested A-HCL M-Hexane <br /> City TAT Requested(days): i"^y B-NaOH N-None <br /> Irvine Ma C-Zn Acetate 0-AsNa02 <br /> State,Zip a D-Nitric Acid P-Na204S <br /> CA,92614-5817 $ E-NaHSO4 Q-Na2S03 <br /> Phone pQ#• ,,yE}� o F-M&0H R-Na25203 <br /> t'r V G-Amchior s-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) ��" o H-Ascorbic Acid T-TSP Dodeoahydrate <br /> Email WO# _ ih1 i-Ice U-Acetone <br /> �y J-DI Water V-MCRA <br /> Projecp K-EDTA W-pH 4-5 <br /> Nestle-Ripon 72000256 Name. Project# = L-EDA Z-other(specify) <br /> Nestlm <br /> Site SSOW#. other: <br /> M <br /> Sampte Matrix m <br /> W <br /> Type (W-w ,s..am m h <br /> Sample (C=comp, �,,,�,,, m <br /> Sample Identification-Client ID Lab ID Sample Date Time G= rab ST —TiCode- <br /> (0 <br /> aNe m � Special Instructions/Note: <br /> U Pritimene iOn Cole: <br /> N <br /> G TH-1 0(720-85891-19) 16:08 <br /> 4!12/18 Pacific <br /> Water X 3 <br /> 4CY) M-30C1(720-85891-20) 4/12118 1627 Water X 3 <br /> O Pacific <br /> v <br /> M-30C2(720-85891-21) 4112118 1634 Water X 3 <br /> M-32A(720-85891-22) 4113118 09.E Water X 3 <br /> PacM-32C(720-85891-23) 4113118 09.;2 Water X 3 <br /> M-32D(720.85891-24) 4113118 09:21 Water X 3 <br /> Pacific <br /> M-32D D(JP(720-85891-25) 4113M8 09'21 Water X 3 <br /> attific <br /> M-38C(720-85891-26) 4113/18 09'38 Water X 3 <br /> Pacific <br /> M-38D(720-85891-27) 4113118 0948 Water X 3 <br /> Pa ift <br /> Note:Since laboratory accreditations are subject to change,TeslAmenca Laboratories,kic places the ownership of method,analyte 8 accreditation compliance upon out subcontract laboratories This sample shipment is forwarded under ohamb6custody i <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than i month) <br /> Unconfirmed Return To Client ©Disposal Fay Lab QArchive For Months <br /> Deliverable Requested:I,if,III,N,Other(specsfy) Primary Deliverable Rank:2 Special Instructions/QC Requirements: <br /> Empty Kr{Relinquished by Date Time Method of Shipment <br /> Rel€ngwshed by Date/Ti a om y 1 Received by DaterTime Company <br /> Relinquished by Date!'{, a Cbmpdny - -,v Received by Date/rime, Company <br /> N) ftel,nqurshed by Datefrime Company Received by Co4wimp <br /> -1:1 <br /> CD Cost osis Intact: Custody Seal No.: Cooler Temperatu and rks <br /> Co AV Yes I A No <br /> Ver:09/24/20 t 6 <br /> n <br />