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1220 Quarry
<br /> Pleasanton Tess} w ,, erica
<br /> Pleasanton,
<br /> A Chain of Custody Record 1� }
<br /> Pleasanton, 84 94566 TRE LFADER 1N ENWRONUENTAt TFHTINC
<br /> Phone(925)484-1919 Fax(925)600-3002
<br /> Sampler Lab PM Carrier Trackrng No(sl COC No
<br /> Client Information (Sub Contract Lab) Smith,Micah F Z tale 720-39511.1
<br /> Client Contact Phone E-Ma IsfatJ of Ongm Page
<br /> Shipping/Receiving micah.smith@testamencainc.com Cafifomia Page 1 of 1
<br /> Company Accreddations Required(See note)- Job#
<br /> TestAmerica Laboratories,Inc NELAP-California;State Program-California 720-88383-1
<br /> Address pyre Dole Requested: preser+satim Codw.
<br /> 17461 De6an Ave, Surte 100, 9/1812018 Analysis Requested A.HCL M-Hexane
<br /> 5-1y TAT Requested(daysl: i`'° B-NaOH N-None
<br /> Imne C-Zn Acetate O-AsNaO2
<br /> State,Zip I;,I +, D-Nit-Acid P-Na2O4S
<br /> CA,92614-5817 ,
<br /> ';�; E-NaH504 O-Nffi503
<br /> Phone pp# ,} ��"+ F-McOH R-Na2S203
<br /> 949-261-1022(Tel) 949-260-3297(Fax) 1+; G-AmchWr S-H25Da
<br /> m + H-Ascorbic Acrd T-TSP Dodecehydrate
<br /> Erraif WO# ��`'' I-Ice U-Acetone
<br /> �h i '•'i'.' J-of Water V-MCAq
<br /> K-EDTA W-pH 4-5
<br /> Project Name Protect#
<br /> Nestle 72000256 �S L-EDA z-Diner(speedy)
<br /> Site SSOW#• a �. Other:
<br /> H
<br /> Sample Matrix
<br /> Type
<br /> Sample (C=comp. 0—w a, ^' ,
<br /> Sam a Identification-Client ID Lab ID Sample Date Time G= rab aT-T"-.AAAA) 1111`' Spec tal Instructions/Note:
<br /> - dy,,;, +.1,. +r8:,1•I �':' i"if' �,h,rl'Y'h" •t" ;1 k1it1� 'e'.'; -
<br /> ns;�, -.i1 i, 1` ,,,•a +i y +'t '�'ty., l a `t., ,� t,;+,t T
<br /> TB-090418(720-88383-1) 914118 Pacific Water XA-
<br /> (N)
<br /> 4
<br /> cNo 7501 KIERNAN 2008 EFF(720-88383-2) 9/4118 10'20 Water X $,
<br /> O Pacific
<br /> c 7501 KIERNAN 2008 MID(720-88383-3) 9!4!18 10:2c Water X
<br /> 7501 KIERNAN 2008 INF(720-88383-4) 914118 10 2Pacif7 Water X
<br /> Pacific
<br /> 5725 HALL 2009 EFF(720-88383-5) 9!4!18 09.58 Water X
<br /> acific
<br /> 5725 HALL 2009 MID(720-88383-6) 914/18 Pac61c Water X
<br /> 5725 HALL 2009 INF(720-88383-7) 9/4118 10'06 Water X '
<br /> Pacific
<br /> 1051 ROBERT(720-88383.8) 9!4!1811.11 Water X
<br /> P c'fic
<br /> Note Since laboratory accreddations are subject In change,TestAmenca Laboratories,Inc places the ownarsh€p of method.analyte 8 accreditation compliance upon out subcontract laboratories TNs sample shipment is forwarded under chain-of-custody If the laboratory does not
<br /> wmenfby maintain accreditation in the State of Origin Fisted above for analys,sRestsfmatnx being analyzed,the samples must be shipped back to the TestAmencs laboratoryor other instructions will be provided Any changes to accreditation status should be brought to TestAmenca
<br /> Laboratones,Inc attention immediately If all requested accreditationS aro current to date,return the signed Chain of Custody attesting to said complicance to TestAmenca Laboratories,Inc
<br /> Possible Hazard Identification Sample Disposal(A fee maybe assessed if samples are retained longer than l month)
<br /> Unconfirmed I =1 Return To Client ©Disposal By Lab Archive For Months
<br /> Deliverable Requested:I,ll,ill,W,Other(specify) Primary Deliverable Rank:2 Special Instruct' nsIAG Requirements:
<br /> E ty 't Relinquished by. Date: Time; 777
<br /> Method of sfnpmem
<br /> e'741T, Daierr,m Compan Recer ed by Daterisme Company
<br /> Ir
<br /> Re nqu hod by Dat a Company Received by. Llai ime. Company
<br /> � Relmqufshed by' paterrime Company Recesved by Oaterfeme Company
<br /> y
<br /> N Custody—seals intact: ustody Seal No.. Cooler Tempereture(s)°C and Other Remarks
<br /> es A No C
<br /> V'�? 1.
<br /> CO Ver.91)110/20 15
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