Laserfiche WebLink
TestAmerica PleasantonIIIIIII IIIIIIII /III II I� I IIIIIIII III �.'�a <br /> ����A�� <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> --Phone-(925)4$4=1919-Fax(925)600-3002 Tn <r nocx rN eNwaarrn=FNrnu TFSTING <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contrat:t Labs Smith,Micah 720-38141.1 <br /> Client Contact: Phone: E-Mail: Stale of Origin: Page: <br /> Shipping/Receiving micah.smith@testamericaine.com California Page 1 of 1 <br /> Company: Accreditation Required(See note): Job#: <br /> TestAmerica Laboratories,Inc. NELAP-California;State Program-California 720-85896-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2417 Bond Street, 4/25/2018 Analysis Requested <br /> - A-HCL M-Hexane <br /> City: TAT Requested(days): - B-NaOH N-None <br /> University Park C-Zn Acetate 0-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> IL,60484 E-NaHSO4 Q-Na2SO3 <br /> Phone: PO#: F-McOH R-H2SO4 3 <br /> 708-534-5200(Tel) 708-534-5211(Fax) c-Amcmor s-H2SO4 <br /> ( ) H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: Z I-Ice U-Acetone <br /> ,_o; +S - J-DI Water V-MCAA <br /> y a K-EDTA W-pH 4-5 <br /> Project Name: Project#: i✓- - L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 720-85896 COC v 9.- <br /> Site: SSOW#: _E ;0:Other: <br /> w - w <br /> •t1 <br /> SampleE. <br /> Matrix � <br /> Type (w=water.$=gaud,U. Z <br /> Sample (C=comp, o=.,esW.11, 3 0 �.- <br /> Sample Identification-Client ID Lab ID Sample Date Time G=grab) sT=ns ,w=ar ii I°—= Special Instructions/Note: <br /> Preservation Code` <br /> M-7A(720-85896-1) 4/13/18 15:30 Water X <br /> Pacific <br /> i <br /> I <br /> i <br /> j® <br /> i <br /> Note:Since laboratory accreditation are subject to change,TestAmerica Laboratories,Inc.places the ownership of method,analyte$accreditation compliance upon out subcontract laboratories. This sample shipment is forwarded under chain-of-custody. If the laboratory does not <br /> currently maintain accreditation In the State of Origin listed above for analysis/tests/matrix being analyzed,the samples must be shipped back to the TestAmerica laboratory or other Instructions will be provided. Any changes to accreditation status should be brought to TestAmerica <br /> Laboratories,Inc.attention immediately. If all requested accreditations are current to date,return the signed Chain of Custody attesting to said complicance to TestAmerica Laboratories,Inc. <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed I Return To Client Disposal By Lab Archive For Months <br /> Deliverable Requested:I,11,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of shipment: <br /> Relinquished by: Da e(rim C yReceiv by: �� D to 'm: i Comp <br /> A /� t <br /> Relinquished by: Date ime: G Company Received by: Date/Time: Company <br /> Relinquished by: Date>Tme: Company Received by: Date/time: Company <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: <br /> A Yes A No r °— <br /> Page 14 of 16 ver:09/20/2016 4/24/2018 <br />