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EurofinTestAmerica,Sacramento Chain of Custody Record <br /> 880 Riverside Parkwayarkway lE,fr(I�ICtY <br /> Y.e <br /> West Sacramento, CA 95605 <br /> Phone:916-373-5600 Fax:916-372-1059 <br /> Sampler Lab PM' Carner Tracking No(s) COC No <br /> Client Information Sub Contract Lab Cortes,Cesar C 320-163088.1 <br /> Client Contact Phone E-Mad State of Ong,n Page <br /> ShippinglReceiving Ices ar tortes@testamencainc,com Califofnla Page 1 of 1 <br /> Company Accreddations Required(See note) Job# <br /> TestAmerica Laboratories,Inc State Program-California 320-55647-1 <br /> Address Due Date Requested Preservation Codes: <br /> 17461 13erian Ave, Suite 140, 71!612019 Analysis Requested <br /> A-HG. M-Hexane <br /> City TAT Requested(days€ <br /> 8-NaOH N-None <br /> Irvine C-Zn Acetate 0-AsNaW <br /> State,71p <br /> D-Nit%Acid P-Na204S <br /> CA,92614-5817 E-NaHSO4 0-Na2803 <br /> F-McOH R-Na2S203 <br /> Phone PO# G-AmcNor S-H2SO4 <br /> 949-261-1022(Tei) 949-260-3297(Fax) 1. G H-Ascorbic Aad T-TSP Dodecohydrate <br /> Email WO# ' '' •�: 3-Ice U-Acetone <br /> J-DI Water V•MCAA <br /> '� k-EDTA W-pH 4-5 <br /> Protect Name Project# .: t- r, L.EDA Z-other(specify) <br /> C+S WHOLESALE GROCERIES 32011469 : uJ <br /> Site SSOW# ', t,! 1LaOther: <br /> rl ,'wit <br /> Sample Matrix <br /> Type Inr weeer, V <br /> Sample ICiscomp, <br /> Sam le Identification-Client lD Lab€D Sample Date Time G- rah eT=r ,nak t w Spacial Instructions/Note: <br /> k,. <br /> ,. ,G, A. <br /> .i <br /> �, <br /> GREASE-1 320 55647-1 <br /> ( ) 10124 119 16"30 Waste X � }• <br /> (D Pacific <br /> 1' <br /> Note Since laboratory aocreddabonS are subject to change,TestAmerica Laboratories,Inc.places the ownership of method.analyte&accreditation compliance upon out subcontract laboratories This sample shipment is forwarded under chain-of-custody. If the€aborstory does not <br /> Currently maintain accreditation in the State of Origin listed above for analysisltestslmatnx being analyzed,the samples must be shipped back to the TaStAmenCa laboratory or other instructions wilt be provided Any Changes to accreditation status should be Aroughl to TestArromrZ <br /> Laboratories,Inc attention immediately If ail requested accreditation are current to date,relum the signed Chain of Custody attesting to said Compl,canO to TestAmerica Laboratories,inc <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed If samples are retained longer than i month) <br /> Unconfirmed I =Return To Client d Disposal By Lab Afrhive For Months <br /> Deliverable Requested 1,11,Ill,IV,Other(specify) Primary Deliverable Rank 2 Special Instructions,10C Requirements: <br /> Empty Kit Relinquished t)y: Date. Time: Method of shipment <br /> Rel, uishadby Dater rime company Received by OatefTime Company <br /> O1 DSII til `' e <br /> e inquished by Daterrime' Company Received by Dateffime. Company <br /> Relinquished by OaterTime Company Recemed by. Dal.,imr E Company <br /> fele�G,/II 3c, <br /> Cil Is Intact: Custody Seal NO.: Cooler Temperature(s)"C and Other Remarks. <br /> O 1 Yes A No <br /> f'`12.D I12- <br />