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7estAmeriPleasanton Test medca <br /> 1220 Quarry Lanene Chain of Custody Record MW <br /> Pleasanton, CA 94566 -nr i rAnro ir;rvVgr?tWF%TAI Trsrsrc <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM• Carver Tracking Nots)• COC No, <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38136-4 <br /> Client Contact Phone E-Matl. State of Origin. Page <br /> Shipping/Receiving micah.smith@testamericaine.com Callfomia Page 4 of 4 <br /> Company Accreditabons Required(See note), Job# <br /> TestAmenca Laboratories.Inc NELAP-California;State Program-California 720-85891-1 <br /> Address, Due Date Requested: Preservatton Codes: <br /> 17461 Derian Ave, Suite 100, 4/25/2018 Analysis Requested A-HCLM-Hexane <br /> City TAT Requested(stays): B-NaOH N-None <br /> Irvine '(, C-Zn Acetate 0-AsNaO2 <br /> State,Ztp• D-NAnc Acid P,Na204S <br /> CA,92614-5817 E-NaHSO4 Q-Na2SO3 <br /> E F-McOH R-Na2S203 <br /> Phone. PO# 0 <br /> U G-Amchlor S•H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) � S H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email WO# c I-Ice U-Acetone <br /> v ` J-Dt Water V-MCAA <br /> Protect Name Protect# � "p K-FDTA W-pH 4-5 <br /> x <br /> L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 m Site SSOW# Other: <br /> m <br /> n Z <br /> Sample Matrix j <br /> Type {w=w.e.,9*soRa M Z <br /> Sample (C=Comp, <br /> Sample Identification-Client ID Lab ID Sample Date Time G--grab) aT.Tb W.A=m)lQ m dt t. Special InstructionslNote: <br /> UX <br /> sv <br /> Preservation Code: <br /> 11:0CDD M-26C2(720-85891-28) 4113/18 P to ACIfi Water X <br /> rn 3 <br /> Oo TH-11(720-85891-29) 4/13118 P1 ific 23 Water X 3 <br /> j M-11C1(720-85891-30) 4113111112:52 WaterX 3 <br /> Pacific <br /> TH-1(720-85891-31) 4/13118 13.09 Water X 3 <br /> Pacato <br /> TH-1 DUP(720-85891-32) 4113118 13-a9 lWaker <br /> X 3 <br /> Pacific M-7A(720-85891-33) 4113/18 13.23 tX <br /> 3 <br /> M-44C(720-85891-34) 4I13f111 P3-� 3M-44C DUP(720-85891-35) 4/13118 1350 3 <br /> Pacific <br /> Note Since laboratory accredrinVOM are subject to change,TestAmerica Laboratories,Inc places the ownership of method.analyte 8 accreditation compliance upon out subcontract laboratories This sample shipment is forwarded under chem-of-custody 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 By Lab ©Archive For Months <br /> Deliverable Requested I,11,III,IV,Other(specify) Primary Deliverable flank:2 Special Instructions/0C Requirements, <br /> Empty Kit Relinquished by: I Date. Time I <br /> Method of Shipment <br /> Reknqulshed b. D telTime• ,.,1 �r,y Received by DatelTime Company <br /> c ` Ct3! V <br /> Relinquished by Date ime- Company Received by. Datemme: Company <br /> Rebnqu lied by Dateffima Company Received by Dae i g' Comgarge� <br /> !1 <br /> 1 015 <br /> N Cu s dy Jeals Intact Custody Seal No.: Cooler Tempera r emarks <br /> O <br /> b Ye � No <br /> 00 Ver-09/20/2016 <br />