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TestAmeriCa Pleasanton ��51m��„�Ca <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 r rn���,�r iV c 7r nrrvrn< srsT•. <br /> Sampler Lab PM_ Carrier Tracking"s)' COC Na <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38136.2 <br /> Client Contact Phone E-Mail State of Ongm: Page' <br /> Shipping/Receiving micah.smdh@testamencalnc.com California Page 2 of 2 <br /> Company: Accreditations Required(See now Job#: <br /> TestAmerica Laboratories,Inc NELAP-California;State Program-California 720-85892-1 <br /> Address Due Data Requested Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 4/2512018 Analysis Requested A.HCL M-He=ane <br /> city. TAT Requested(days): (�, B-NaOH N-None <br /> Irvine C-Zn Acetate O-AsNaO2 <br /> ; D-Nitric Acai P-Na204S <br /> Stale Zip E-NaHSO4 0-Na2SO3 <br /> CA,92614-5817i' F-McOH R-Na2S203 <br /> Phone PO# i��'}', > <br /> 949-261-1022(Tel) 949-260-3297(Fax) t G-Amchlor S-H2SO4 <br /> 6 •;fit :3 H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email WO# ` d 1-106 U-Acetone <br /> J-Dl Water V-NCAA <br /> ProjectName- Protect# J 11-EDTA W-pH 4.5 <br /> Nestle-Ripon 72000256 <br /> L-EDA Z-other(specify) <br /> Ste SSOW# C Other: <br /> Sample Matrix _ <br /> TYPe (w-.,�.s4oxa <br /> Sample � Nt <br /> {C=comp, o..„im,n, c <br /> Sam pie Identification-Client Ib Lab 10 Sample Date Time G= rah aT-M..-,MAJI 12 n r= S ecial Instructions/Note: <br /> a <br /> N Preservation Code: IX <br /> c(0D CALTRANS(720-85892-10) 4112118 08'34 Water X 3 <br /> Ca <br /> Pacific <br /> Ca <br /> PW-6(720-85892-11) 4113118 10,32 Water X 3 <br /> p Pacific <br /> W <br /> PW-8(720-85892-12) 4/13118 10,39 Water X 3 <br /> � <br /> Pacific <br /> Note Since laboratory accreditaticns are subject to change,TestAmenca Laboratories,frit places the ownership of method,ana€yte&accreditation compliance upon out subcontract laboratories This sample shipment is forwarded undef chain-of-custody l <br /> Possible Hazard Identification 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,III,lV,Other(specify) Primary Deliverable Rank,2 Special Instructions/QC Requirements- <br /> Empty Kit Relinquished by. Date: Time: Method of Shipment <br /> Relinquished by C, Datefrime: ny Reserved by Date/Time, company <br /> Relinquished by Date a Company Reeewed by: Date/Time, Company <br /> Relinquished by Dateriime Company Recewed by- DateLfilrfljo Com yt <br /> N >rUf <br /> O Cuffty Sipials Intact: Custody Seal No.: Cooler Temper ana emarks <br /> 00 Yes A No <br /> Ver,0/2012016 <br /> e nn F <br /> n <br />