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TestAmerica Pleasanton I II IIAI TestAmerica <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 THF IF AEIFsr IN FNVIRONr✓FNTAI rFSTING <br /> Sampler Lab PMC,ar(ler Track o OC No <br /> Client Information (Sub Contract Lab) Smith,Micah �-t 524 20-393851 <br /> Client Contac Phone E-Mai# State of Origin, Page <br /> ShlppinglReoeiving micah_smith@testamencainc.com California Page 1 of 1 <br /> Company Accreddations Required(gee note)- Job# <br /> TestAmenca Laboratories,Inc NELAP-CalifomW State Program-California 720-88168-1 <br /> Address Due Date Requested: Preservation Codes: <br /> 17461 DerianAve, Suite 100, 916/2018 Analysis Requested A-HCL M-Hexane <br /> City TAT Requested(days): 9-NaOH N-None <br /> Irvine C-Zn Acetate 0-AsNa02 <br /> Stat e•Zip D-Nitric Acid P-Na204S <br /> CA,92614.5817 E-NaHSO4 0-Na2SO3 <br /> Phone PO# F-Mepti R-Na25263 <br /> 949-261-1022(Tel) 949-260-3297(Fax) H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email- W O# J_ I-ice U-Acetone <br /> u�11i '•,� J-DI Water V-MCAA <br /> Project Name Protect# ii K-EDTA W-pH 4-5 <br /> Nestle 72000256 L-EDA Z-other(specify) <br /> Site SSOW# n Other: <br /> Sample Matrix = „ <br /> Type <br /> 3=aur d. -J <br /> Sample (C=comp, OavaamfoiA r <br /> Sam ie Identification-Client ID Lab IDJ Sample Date Time G=grrayyb ,.-,,A=Air) H ij«' Special InstruetionslNote: <br /> ?4Omt9*_�Colt.' <br /> N TB-082118(720-88168-1) 8121118 Pacific „ <br /> 10:58 <br /> Wafer X 2' <br /> 7501 KIERNAN 2008 EFF(720-88168-2) 8121118 12'50 Water X .3 <br /> 0 Pacific <br /> 2. <br /> N 7501 KIERNAN 2008 MID(720-88168-3) 8121118 P2 to Water X <br /> fV <br /> 5725 HALL 2009 EFF(720-88168-4) 8121118 12:32Pacif Water X 9 <br /> 5725 HALL 2009 MID(720-88168-5) 8121118 1235 Water X <br /> Pacific <br /> ln' <br /> Nate Since laboratory accreditation are subject to change.TestAmenca Laboratories,Inc.places the ownership of method,analyte 8 accreditation compliance upon out subcontract laboratories This sample shipment is forwarded under chain-of-custody if She laboratory does not <br /> currently maintain accreditation in the State of Origin#fisted above for anakysisftesislmatdx being anatyzed,the samples must be shipped back to the TestAmenca laboratory or other instructions will be provided Any changes to accreditation status should be brought lo TestAmenca <br /> Laboratories,Inc attention immediately if all requested accreddations are current to date,return the signed Chain of Custody attesting to said comp€icance to TestAmenca Laboratories.inc <br /> Possible Hazard IdentiricationSample Disposal(A fee may be assessed 1f samples are retained longer than 1 month) <br /> Unconfirmed Return To Client ©Disposal By Lab Archive For Months <br /> Deliverable Requested:1,It,III,IV,Other(specify) Primary Deliverable Rank:2 Special InstructionslOG Requirements: <br /> Emp efinquished by: I Date: Time: Method of shipment <br /> Rel'quished b Dat Co a y Received by DatelTime. Company <br /> 1,5__,� 7 <br /> Relinquis ed Daterritine Company Received by, DaWTlme Company <br /> 170 <br /> N) Relinquished by DatefTime Company Received by D Q>Y; ,r f Co <br /> NV,,ff±E <br /> t/�C:/S YNR t't1 <br /> O Cust dy ais intact. Custody Seal Na.: Cooler Temperature(s)°C an s fyn <br /> 00 <br /> p Yes 4 No Ver:091�012016 <br /> n <br />