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TestAmerica Pleasanton II�III�uI�IN�III��I�I�II <br /> 1220 Quant'Lane Chain of Custody Record T estAme�ry lca <br /> Pleasanton, CA94566 <br /> THF LEADER IN ENVIROMMENTAL TESTING <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Samples Lab PM: Carrier Tracking NO(s): COC No: <br /> Client Information Sub Contract Lab) Clark,Heather 720-40731.1 <br /> Client Contact: Phone: E-Mail: State of Origin: Page: <br /> Shipping/Receiving iheather.clark@testamedcainc.com California Page 1 of 1 <br /> Company. Accredltations Required(See note): Job#: <br /> TestAmerica Laboratories,Inc. 720-90502-2 <br /> Address: Due Date Requested: Preservation Codes: <br /> 1100 NE Circle Blvd, Suite 310, 1/15/2019 i •t�`�` J Analysis Requested A•HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Corvallis C-Zn Acetate 0-AsNa02 <br /> Stale.Zr D-Nitric Acid P-Na204S <br /> OR,97330 0 E-NlHSO4 0-Na2S03 <br /> m F-McOH R-Na2S203 <br /> Phone: PO#- G-Amchlor S-H2SO4 <br /> 541-243-0980(Tel) a ^, H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: We#: Z 3 1-Ice U-Acetone <br /> N J-Dl Water V-MCAA <br /> Project Name: Project#: m is r L-EDA Z•other 44 5(specify) <br /> UPRR-French Camp 72012048 m a 8 <br /> Site: SSOW#: <br /> m n Other. <br /> a; `o <br /> Sample Matrix 8 3 <br /> Type (ww,e..,saona � <br /> Sample (C=Comp, <br /> Sample Identification-Client ID Lab ID Sample Date Time G rab eT_n+»,A w LL 'n hSpecial Instructions/Note: <br /> N <br /> Preservation Code: <br /> N HYDAASTE(720-90502-5) 12/21118 1119Pacific Solid X <br /> N <br /> O <br /> W <br /> Ni Since laboratory accreoitations are subject to Change,TestAmerlCa Laboratories.Inc.places the a narshlp of method,analyte&accreditation compliance upon out subcontract laooratories. This sample shipment is fornarded under chain-of-custody. I`the laboratory does not <br /> currently maintain accrediiater in the State of Origin Isted above for analysis/tests/ri being analyzed,the samples must be snipped back to the TestAmerica laboratory or other Instructions wil be provided. Any changes to accreditation status should be brought to TestAnnerica <br /> Laboratories,Inc.attention immediately. If all requested accreditations are current to date,return the signed Chain of Custody attesting to said cornplicance 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 71Dis osai By Lab Archive For Months <br /> Deliverable Requested:I,II,Iii,IV,Other(specify) Primary Deliverable Rank:2 Special Instructions=Requirements: <br /> y Relinquished by: Date: Time: Method of Shipment <br /> elin4 by: i DateR'ig_, _ Compo Re ad by: _� Dale/Tlme: Company <br /> L i <br /> RelinquisIvA by Dat ime: Company Received by DatalTme: Company <br /> N Relinquished by: Date/Trne: Company Received by: Daterrime: Company <br /> A <br /> CD Custody Seals Intact Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: <br /> CD CD A Yes a No <br /> Ver:09/202016 <br /> 13 <br />