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T20 Qua" rare Pleasanton Chain of Custody Record Iq��l� Il� pl l TestAmedca <br /> 1220 Quarry Lane <br /> Pleasanton, CA 94566 <br /> -Nr IFAOFR IN FNVIRFYNMFh'T At TF STING <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM Camer Tracking No(s): COC No <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38512.1 <br /> Client Contact Phone E-Mall State of Origin- Page' <br /> Shipping/Receiving micah.smith@testamericainc.com lCatifornia Page 1 of 1 <br /> Company Accreditation Required(See note), Job#. <br /> TtastAmenca Laboratories,Inc NELAP-California;State Program-Califomia 720-86540-1 <br /> Address, Due Date Requested: Preservation Codes: <br /> 17461 Derian Ave, Suite 100, 5/31/2018 Anal sisRequested A-HCL M-Hexane <br /> CiW TAT Requested tdays): 8-NaOH N-None <br /> Irvine C-Zn Acetate 0-AsNa02 <br /> State,Zip •,�i D-NINc Acid P-Na204S <br /> {� �`�''�S E-NaHSO4 0-Na2SO3 <br /> GA,92614-5817 A F-MeoH R-Na2s203 <br /> Phone PO# ,�1„ G-Amchlor S-H2SO4 <br /> 949-269-1022(Tel) 949-260-3297(Fax) m H-AseobrcAcid T-TSPDodecahydrate <br /> Email, WO#: I-ice U-Acetone <br /> 1 J-DI Water V-MCAA <br /> Project Name Project p' K-EDTA W-pH 4-6 <br /> fe t 3 L-EOA Z-other(specify) <br /> Nestle-Ripon 72000256 .9 <br /> Site SSOW#. t Other: <br /> Sample Matrix <br /> Type . LL D <br /> S-did, I <br /> Sample (C-comp, o._. 1' <br /> Sample Identification-Client ID Lab ID) Sample Date Time G=grab) aT.nuua.A.Ah n n I I I I I I I Special Instructions/Note: <br /> i,`t:, <br /> N TS-051718(720-86540-1) 5/17118 G8;15 Water' X <br /> tV ' <br /> o 7501 KIERNAN 2008 EFF(720-86540-2) 5117118 08-51 Water X ' <br /> IV 7501 KIERNAN 2008 MID(72D-86540-3) 5117118 Pc Ic Water X <br /> W <br /> 5725 HALL 2009 EFF(720-86540-4) 5/17118 09'23 Water X <br /> 5725 HALL 2009 MID(720-86540-5) 5117/18 09'27 Water X $3' <br /> Pacific <br /> i <br /> Note.Since laboratory accfeditabons are subject to Change,TestAmerica Laboratories,Inc.places the ownership of method,analyte 8 accreditabon compliance upon out subcontract IaboratoneS.This sample shipment is fomented under chain-of-custody If the laboratorydoes not <br /> currently maintain accreditation in the State of Origin listed above for anaiyslsltestslmainx being analyzed.the samples must be shipped back to the TestAmenca laboratory of otter ma ucbons will be prmded. Any changes to accremlatton status should be brought to TestAmenca <br /> Laboratories,Inc attention immediately.If all requested acCredilAWOrs are current io date,return the signed Chain of Custody attesting to said compimance to TestAmerlca Laboratories.Inc. <br /> Possible Hazard ldentiRcafion Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed I =Return To Client ©bis sal By Lab ©Archive For Months <br /> Deliverable Requested:I.II,III,IV,Other(specify) Primary Deliverable Rank:2 Special InstructtonsIOC Requirements <br /> Eiiyfy Kit ehnquished by. Date: Time: Method of shipment <br /> R quis Datelrl g Company Received by. DatefTime Company <br /> RelincVby Dat me Company R ved by Daterrime. Company <br /> U1 <br /> fV Relinquished by OatolTime: Company <br /> C\Ji � 11 <br /> C:) Cuod Seals intact: Cu o.: q Coot <br /> 00 1 te T peralu amad s <br /> d o No <br /> Ver.pg1?0120]6 <br /> \j <br /> e nn � n <br />