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TestAmeaPleasanton <br /> Lane <br /> 1220 Quarry Lane Chain of Custody Record i j� j TestAmerica <br /> Pleasanton, CA 94566 <br /> THF lFR[)rrx IN i�Jyrq(7Kl/FyT/i Tr STrK� <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> samples ab PM' Carrier Tracking No(s) COC No <br /> Client Information (Sub Contract Lab) Smith,Micah 720-38776.1 <br /> Ghent Contact, Phone- E-Mail State of Oron, Page <br /> ShipptnglReceiving micah.smith@testamencainc.com California Page 1 of 1 <br /> Company. Accreditatrons Required(See note). Job#• <br /> Testqmerica Laboratories,Inc NELAP-California;State Program-California 720-87017-1 <br /> Address Due Date Requested: Preseervation Codes: <br /> 17461 Der9anAve, Suite 100, 6/27/2018 Analysis Requested A-HCL M-Hexane <br /> City TAT Requested(days?. 8-Na0H N-None <br /> Irvine C-Zn Acetate O-AsNa02 <br /> State,Zip D-Nitnc Acid P-Na204S <br /> CA,92614-5817 e-NaHSO4 0-WSW <br /> Phone PO# F-MeCH R-Na2S203 <br /> G-Amohlor 5-H2504 <br /> 949-261-1022(Tel) 949-260-3297(Fax) _w H-Ascorbic Acid T-TSP Doderahydrate <br /> Email- W0# I-Ice U-Acetone <br /> , J-Dl Water V-MCAA <br /> tt#. Ai Z K-EDTA W-pH 4-5 <br /> Pro ect Name Protein <br /> L-EDA z-other{spec(specify)Nestle-Ripon 72000256 <br /> site* SSOW# c Other: <br /> n <br /> m <br /> Sample Matrix <br /> Sample (C camp, <br /> Sample Identification-Client ID Lab IR Sample Date Time G=grab aTw--,ll m SI Special Instructions/Note: <br /> CD <br /> T13-061518(720-87017-1) P <br /> 7017-1) 6115118 0 Pacific WaterX,� <br /> 8:30 2„ <br /> CD 7501 KIERNAN 2008 EFF(720-87017-2) 6115118 09.16 Water X 3' <br /> O Pacific <br /> N7501 KIERNAN 2008 MID(720-87017-3) 6/15118 09.19 Water X 3 <br /> NI Pacific <br /> 5725 HALL 2009 EFF(720-870170 6115118 08'57 Water X 3. <br /> Pacific <br /> 5725}TALL 2009 MiD(720-67017-5) 6115118 09'02 Water X 3r <br /> Pacifi <br /> Note Since laboratory acceditatlons are subject to change,TestAmenca Laboratories,Inc.places the ownership of methad,analyte 8 accreddapon compliance upon out subcontract laboratones This sample shipment is forwarded under Chainref-Custody If the laboratory does not <br /> currently maintain accreditation in the State of Ongln listed above for analyslsttesWrnatrlx being analyzed,the samples must be shipped back to the TestAmenca laboratory or other instructions will be provided Any changes to aceredltaton status should be brought to TestAtnenca <br /> Laboratories,Inc attenhon immediately If all requested accreditation are a.lrrent to date,return the signed Chan of Custody attesting to said compltcance to TestAmenca Laboratories,Inc <br /> Possible Hazard ldenfificafion Sample Disposal(A fee may be assessed ifsamples are retained longer than f month) <br /> Unconfirmed I 1=1 Return To Client '= Dsposaf19Lab Archive For Months <br /> Deliverable Requested,1,11,III,IV,Other(specify) Primary Deliverable Rank-2 Special Instructions=Requirements: <br /> Empty Kit Relinquished by: Date Time- <br /> Method ofShapment. <br /> Relinquished by Date dny Received by_ Dat fri ` <br /> �-7 C74Lie <br /> 57—(81 <br /> Rehnqu,shed by. DatalTsme. Company Received by Dat!Time- 4y1t Company 1C <br /> N <br /> ReArx}urshed try. OatelTlme Company Received by DaterTime- Company <br /> N <br /> N Custody Seals Intact: Custody Seal No.. yrs' /� ]! �"j Cnaer remperature(s)°C and Ocher Remarks. ,+� /� <br /> 0 Yes d Na / 7 `/ V LJ° ' r / e9 <br /> 00 Ver.09l20r?016 <br />