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ns TestAmerica,Pleasanton <br /> 1220Qu II II IIIIIIIIIII I IIIIIIIIv�eurofins Environment Testing <br /> Pleasanton. CA466 Chain of Custody Record TI <br /> Phone:925484-1919 Fax:925-600-3002 I <br /> Sampler. Lab PM: Canter Tracking.No(sl: COC No: <br /> Client Information (Sub Contract Lab) Capgras,Criselda 720.43869.1 I <br /> Client Contact: Phone: E-Mail: Slate of Origin: Page: <br /> Shipping/Receiving offseida.caparas@testamedcainc.com California Page 1 of 1 <br /> Company Amnadilatlons Required(Sae note): Job#: I <br /> TestAmerica Laboratories,Inc. 720-95524-1 <br /> Address: Due Data Requested: Preservation Codes: <br /> 2417 Bond Street, 10/21/2019 Analysis Requested <br /> Cl(y: - 9 A-HCL M-Hexane <br /> TAT Requested(gays): B-NaOH N-None <br /> University Park <br /> —State,Zip: 9-20.95524-GGG— ---- - --- ` O-zn Acetate O•N&2048 <br /> -__..__. D=N'Gc Acid. ..P=Na20M1S-- <br /> "�E-NoHSO4 0-Na2SO3 <br /> Phone:84 --.'F-MeOH R•Na2S2O3 <br /> Phone: PO#: ;y; 'r� G-Amchlor S•H2SO4 I <br /> 708-534-5200(Tel) 7085345211(Fax) a'F H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: I-tce U-Acetone <br /> J-Dl Water V-MCRA <br /> �. I <br /> Project Name: Project#: _a ' K-EDTA Z- H4S <br /> 321 Main Street SPE#12 Farmington CT 72014769 a w4 L-EDA z-owerp (specify) <br /> she: ssow#: i� < '$' <br /> Other: �I <br /> Sample _ <br /> Matrix E I <br /> Type - <br /> Sample (C-comp,reo a <br /> Sample Identification-Client ID Lab ID reP. <br /> Sam le Date Time G=grab) e.n w.a, w 8 - S tial Instructions/Note: <br /> -.. <br /> 09:50 <br /> 100419 A(720-95524-1) 1014/19 Water X X I <br /> Pacific <br /> I <br /> 101 <br /> ���ymyy <br /> A". <br /> � <br /> xh <br /> Note:Since laboratory accreditatons are subject to change,TestAmedoa Labom odes,Inc.places the ownership of method,analyte&accreditation compliance upon out subcontract laboratories.This sample shipment is forwarded under chainofsustody.if the laboratory does not <br /> currently maintain accreditation In the State of Origin listed above for anelyalsilestshnatdx being analyzed,the samples must be shipped back to the TestAmedca laboratory or other Instructions will be provided.Any changes to accreditaton status should be brought to TestAmerica <br /> Laboratories,Inc.attention immediately.If all requested awreditations are current to date,return the signed Chain of Custody attesting to said wrnplicance to TestAmerica Laboratories,Inc. <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed If samples are retained longer than t month) <br /> Unconfirmed I =]Retum To Client Disposal By Lab Archive For Months <br /> Deliverable Requested:1,II,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions=Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of shlpmenl: <br /> Relinquished by. DateRime: _ Compai9p� Receivetl b D mp y <br /> ,5M1 <br /> Relinquished by Da /11me: Company ReonW aby: Date me: CoMITany <br /> Relinquished by DateMme: Company Received by Daterfime: Company <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)oC and Other Remarks: <br /> 4 Yes d No <br /> age ztbD Of ver:MUAMY2 U 19(Rev. 1 <br />