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TestAmerica San Francisco 71V,��3 <br /> ���� ��� <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> .r r a;�a;r �, e;�z r •r°.rn.- �.rMs.a. <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 720-10050.1 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#. <br /> KIFF Analytical Anal sis Requested 720-30689-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, 10/5/2010 A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> Stale,Zip: D-Nitric Acid P-Na204S <br /> CA,95616 E-NaHSO4 Q-Na2SO3 <br /> F-McOH R-Na2S2SO3 <br /> Phone: PO#: <br /> a G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: ,N I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> Project Name: Project#: "r K-EDTA W-ph 4-5 <br /> t) L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 a <br /> Site: SSOW#: _ Other <br /> U <br /> Sample Matrix s <br /> Type (W-water, Z <br /> Ix <br /> x <br /> ssenn, U <br /> 1`0 Sample (C=comp o.wa,aren, j <br /> ty Sam le Identification Client ID Lab ID Sample Date Time G=Arab) aT TISSua,A•Air y Special Instructions/Note <br /> Ns <br /> F' 7501 KIERNAN 2008 EFF(720-30689-1) 9/21/10 14'09 Water X Q <br /> F-' P ifi <br /> O 7501 KIERNAN 2008 MID(720-30689-2) 9/21/10 14:12 Water X 0 2 <br /> 1-h Pacific <br /> F� 5725 HALL 2009 EFF(720-30689-3) 9/21/10 13-50 <br /> Water X 3 <br /> w <br /> 5725 HALL 2009 MID(720-30689-4) 9/21/10 13:53Pacific <br /> Water X Q <br /> TB-092110(720-30689-5) 9/21/10 10:57 Water X <br /> Pacific <br /> �a- <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =Non-Hazard =Flammable Skin Irritant Poison 8 Unknown Radiological =Return To Client = Disposal By Lab Archive For Months <br /> Deliverable Requested: I,II, Illh IV,Other(specify) Special Instructions/QC Requirements: <br /> v <br /> CD <br /> (D Empty Kit Relinqui by: f Date: Time: Method of shipment: <br /> Relinquished by: Dat /\ Com Received by: Date/Time:I / wV. Company <br /> O (J <br /> Relinquished by: Date e: Compa Racei d Dale/Ti C pany <br /> Relinquished by. ate/Time. Com Rby: Deaterrim: iO <br /> /4qq 1t <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: <br /> 0 Yes e No <br />