Laserfiche WebLink
Test <br /> 2200 QAmryLaca Pleasanton �� l II�III IN�Ip� l TestAmedca <br /> Chain of Custody Record '„ <br /> Pleasanton, CA 94566 THF LF,ADFR 1N FVVSRONMFNTAI TESTING <br /> Phone(925)464-1919 Fax(925)600-3002 <br /> Sampler Lab PM Camer Tracking No(s) COC No <br /> Client information (Sub Contract Lab) Smith,Micah „t� 720-38195.1 <br /> Ghent Contact Phone E-Mail State of Origin Page <br /> Shipping/Receiving 1-icah.smith@testame6cainc.com California Page 1 of 1 <br /> Company Aweddabons Required(See note) Job# <br /> TestAmenca Laboratories,Inc NELAP-California;State Program-California 720-85957-1 <br /> Address Due elate Requested: Preservation Codes: <br /> 17461 Derian Ave, Suite 100. 413012018 Analysis Requested A.HCL M-Hexene <br /> my TAT Requested(days): <br /> Irvine 8-NaOHN-None <br /> C-Zn Acetate 0-AsNa02 <br /> state,Zip •'' D-Niinc Acid P-Na204S <br /> CA,92614-5817 E-NaHSO4 O-Na2SO3 <br /> Phone PO# Y '+ F-McOH R-Na2S203 <br /> 949-261-1022(Tel) 949-260-3297(Fax) G-Amch or 5-H2SO4 <br /> ( ) m H-Ascorbic Acid T-TSPDodewhydrate <br /> Ema$l WO# I-1. U-Acetone <br /> J-Dl Water V-MCAA <br /> 72000256 1 '4� K-EDTA W-pH 4-5 <br /> Nestle-Ripon 7200 <br /> Protect Name # S L-EDA 2-Other(Specify) <br /> � <br /> Site SSOW# a Other: <br /> Sample Matrix = , <br /> Type (wr. ' <br /> Sample (C=comp, 0,hW;,r, <br /> Sam le Identification-Client ti? Lab IA Sample bate Time G=grab) 13T.T..,A-Awl � �` Special instructions/Note: <br /> rQ <br /> (D TB-041718(720-85957-1) 4117/18 08: 8 Water X''.,: <br /> NPacific 2-1 <br /> 09:00 <br /> 0 7501 KIERNAN 2008 EFF(720-85957-2) 4117118 Pacific Water X $' <br /> N 7501 KIERNAN 2D08 MID(72D-85957-3) 4117!18 09:03 Water X ; <br /> cific <br /> 5725 HALL 2009 EFF(720-85957-4) 4117118 P09:fic Water X 8• <br /> 5725 HALL 2009 MID(720-85957-5) 4117118 09.24 Water X 3 <br /> Pacific <br /> " v <br /> •d <br /> Note Since laboratory accreddations are subject to change,TestAmenca Laboratories,fno places the ownersh¢p of method,analyte&accreditation compliance upon out subcontract laboratones This sample shipment is forwarded under chain-of-custody if the laboratory does not <br /> currently maintain accred4auon in the State of Origin listed above for analysisRestslmatrix being analyzed,the samples must be shipped back to the TestAmenca laboratory or other instructions will be provided Any changes to accreditation status should be brought to TestAmenca <br /> Laboratories,Inc attention immediately If all requested aecreddations are current to dale,return the signed Chain of Custody attesting to said comphcance to TestAmenca 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 Py Lab ©Archive For Months <br /> Deliverable Requested I,II,III,IV,Other(specify) Primary Deliverable Rank:2 Speciale Instructions lOC Requirements. <br /> Empty Kit Relinquished by: Date: Time: Method of Shipment <br /> Refinqu€shed by IJaI line Cv Received by DaterTtme Company <br /> Reimqufshed by OaYerrime Compa Received by DaterFime Company <br /> Re#inqutshed by Date/Time Company ecervef'W Dateffl e• .� Com an <br /> `I!o s' <br /> N <br /> O Custe gals Intact' Custody Seal No., Cooler Te ture(s)°C and Other Remarks ` <br /> 00 KYes o No <br /> Ver:0912012016 <br /> e nn F <br /> n <br />