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TestAmerica Pleasanton III III III IIIIIIIIIIIIII II I IIIIIIIIIIII Testes erica <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> THE LEADER IN ENVIRONMENTAL TESTING <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-33586.1 <br /> Client Contact: Phone: E-mail: State of Origin: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com California Page 1 of 1 <br /> Company: Accreditations Required(See note): Job#: <br /> Aquatic Testing Laboratories State Program-California 720-78845-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 4350 Transport#107, 4/14/2017 Analysis Requested A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Ventura C-Zn Acetate O-AsNa02 <br /> State,Zip: m D-Nitric Acid P-Na204S <br /> m E-NaHSO4 Q-Na2SO3 <br /> CA,93003 m IF <br /> Phone: <br /> R-Na2S203 <br /> Phone: PO#: m ffG-Amchlor S-H2SO4 <br /> m " H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: N; .: I-Ice U-Acetone <br /> Q " J-DI Water V-MCAA <br /> _ K-EDTA W-pH 4-5 <br /> Project Name: Project#: , <br /> UPRR-Ret Tank-Stockton 72012176 a L EDA Z-other(specify) <br /> Site: SSOW#: o_ Other: <br /> In •� <br /> Sample Matrix ; <br /> Type <br /> Sample (C=comp, os limn, m <br /> Sam le Identification-Client ID Lab ID Sample Date Time G=grab) eT m ,A•Alr U) Special Instructions/Note: <br /> � c ht8l61lrV!ltlOfl <br /> O Pacific 3670-TANK(720-78845-1) 4/10/17 aWater X <br /> � Pacific <br /> O <br /> CTIN <br /> Note:Since laboratory accreditations are subject to change,TestAmerica Laboratories,Inc.places the ownership of method,analyte d accreditation compliance upon out subcontract laboratories. This sample shipment is forwarded under chain-of-custody. If the laboratory does not <br /> currently maintain accreditation in the State of Origin listed above for analysis/tests/matrix being analyzed,the samples must be shipped back to the TestAmerica laboratory or other instructions will be provided. Any changes to accreditation status should be brought to TestAmerica <br /> Laboratories,Inc.attention immediately. If all requested accreditations are current to date,return the signed Chain of Custody attesting to said complicance to TestAmerica Laboratories,Inc. <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Unconfirmed =Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of shipment. <br /> Relinquished by: Datefli i Company Received by Daterrime: Company <br /> 4 ;f <br /> 00 Relinquished by: Dat im Company Receive Date/Time: Company <br /> N <br /> CD Relinquished by: DatefTime: Company Received by: Daterrime: Company <br /> 1 <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: <br /> Yes 0 No v <br /> e <br />