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TestAmerica Pleasanton <br /> 1220 quarry Lane Chain of Custody Record I�IIII III �MI� ��I TestAnnenca <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 TH{lFO SFR fM�4VrR]NMFVY Pt FSTiN[ <br /> Sampler, Lab PM: Carrier Tracking No(s) COC No <br /> Client Information (Sub Contract Lab) Smith,Micah '3 t { $ 720-38373.1 <br /> Client Contact Phone* E-Mail, State of Origin. Page. <br /> Shipping/Receiving micah.smithi testamericainc.com Califomla Page 1 of 1 <br /> Company. Accreditation Required(See note), Job#' <br /> TestAmerica Laboratories,Inc NEL.AP-California;State Program-California 720-86259-1 <br /> Address. Dire Date Requested: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 5/15/2018 Analysis Requested A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Irvlrie I., C-Zn Acetate 0-AsNa02 <br /> State,Zip D-Nitric Acid P-Na204S <br /> CA,92614-5817 m E-NsHSO4 0-Na2SO3 <br /> C, F•McOH R-Na25203 <br /> Phone: PO#- ? G-AmcMor S-H2SO4 <br /> 949-261-1022(Tel) 949-260-3297(Fax) H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: W O#. i-Ice U-Acetone <br /> �i J•DI Water V-MCAA <br /> Project Name Protect#. ' •' K-EDTA W-pH 4-5 <br /> Nestle-Ripon 72000256L-EDA Z-other(specdy) <br /> site, SSOW#. 'Other: <br /> m <br /> Sample Matrix = <br /> Type (vrwerw. i <br /> Sample (C=comp, oil HI <br /> Sample Identification-Client 1D Lab ID Sample Date Time G=grab) 13r-T1.—Awr 2 -+w, 3 cial InstructionstNote- <br /> X X1 ;'y <br /> Al <br /> CDD TB-050218(720-86259-1) 512118 13:15 Water X <br /> P ift <br /> t13:40 <br /> N 7501 KIERNAN 2008 EFF(720-86259.2) 512!18pac''c Water X ;3, <br /> O <br /> c 7501 KIERNAN 2008 MID(720-86259-3) 512/18 aWater X 3 <br /> � Pacific cifi <br /> 7501 KIERNAN 2008 INF(720-86259-4) 512118 Pacific Water X <br /> 5725 HALL 2009 EFF(720-86259-5) 512/18 14:01 Water X <br /> Pacific <br /> 5725 HALL 2009 MID(720-86259-6) 512118 14,05 Water X •; <br /> Pacific <br /> 5725 HALL 2009 INF(720-86259-7) 5!2118 14:10 Water X 4 <br /> Pacific <br /> 1051 ROBERT(720-86259-9) 512118 13-50 <br /> 3 50 Water XPacif <br /> ''i <br /> Note.Since laboratory accreditation are subject to change,TestAmenca Laboratories,Inc places the ownership of method,analyte 8 accradkahon compliance upon out subcontract taboratones.This sample shipment is forwarded under chainbf-custody If the laboratory does not <br /> currently maintain accreditation in the State of Origin listed above for anatysisitestslmatrix being ana{yzed,the samples must be shipped back to the TeslAmenca laboratory or other instructions wit#be provided Any changes to accreditation status should be brought to TestAmence <br /> Laboratories,Inc.attention Immediately if all requested accreditation are current to date,return the signed Chain crFCustody attesting to said compticance to TeslAmenca Laboratories,tnc. <br /> Possible Hazard ldenrlfieation Sample Disposal(A fee may be assessed If samples are retained longer than 1 month) <br /> Unconfirmed I =Return To Client =Disposal By tab ©Archive For Months <br /> Deliverable Requested:I,II,111,IV,Other(specify) Primary Deliverable Rank 2 Speclal Instructions/0C Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of Shipment. <br /> Relinquished by. DaielTl e C y Received by DaterTlme• Company <br /> — ( (0 <br /> Relinquished by Date rine Company Received by Datefrime. Company <br /> U1 <br /> Relinquished by. Datefrime Company Reoeived by Datefr ,G� Compan <br /> 00 U <br /> D Gus y IS Intact: Custody Seal No.: Gooier Temperawre(s)° r ema �� <br /> 00 Yes No [� <br /> Ver 04720/2016 <br /> n <br />