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TestAmerica San Francisco <br /> Plea Quarry Lane Chain of Custody R Test rn ra <br /> Pleasanton, CA 94566 y ecord � � I <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 7zo-boas 1 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: <br /> KIFF Analytical Job# <br /> Anal sis Requested 720-30779-1 <br /> Address: Due Date Requested: <br /> 2795 Second Street,Suite 300, 10/8/2010 {F Preservation Codes: <br /> City: A-HCL M-Hexane <br /> TAT Requested(days): ,•. <br /> Davis - `� OAcetate 0-AsNa02 <br /> State,Zip: <br /> CA, C-Zna D-Nitric Acid P-Na204S <br /> Phone.95616 Fri E-NaHSO4 Q-Na2S03 <br /> Pho ' <br /> PO#: z." �� F-McOH R-Na2S2S03 <br /> w -- G-Amchlor S-H2SO4 <br /> Email, WO N H-Ascorbic Acid T-TSP Dodecahydrate <br /> W) I-Ice U-Acetone <br /> aF J-DI Water V-MCAA <br /> Project Name: Project#: m tba. K-EDTA W-ph 4-5 <br /> Nestle-Ripon 72000256 p ', L-EDA Z-other(specify) <br /> Site. SSOW# 7 <br /> Other: <br /> H <br /> Sample Matrix ( <br /> Type (w.wat<r, ZO ' <br /> Nb s <br /> Pti <br /> ., <br /> Sample (C�y com , o a <br /> eo �m <br /> SamIe Identification Client ID Lab ID Sample Date Time rab a,r. uaat rn <br /> Special <br /> 802 VERA MID(720-30779-2) 9/27/10 14.15 Water X <br /> to <br /> --Pacific of <br /> D <br /> 802 VERA INF(720-30779-3) 9/27/10 14:25 Water X <br /> Pacific <br /> A` U <br /> Hh <br /> N <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 B Unknown Radiological 0 Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested: I, Ii,III, IV,Other(specify) Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by: Date: Time: Method of shipment <br /> Relinquished by: Da ime, �_ O Com y Received by: <br /> CD Coman <br /> Z <br /> c S <br /> 0 Relinquished by: 7 Date/Time. Company Received by. Date/Time: Company <br /> (9 Relinquished by. Date/Time: Company R ceived by DatelTime: Compan <br /> lD 7t <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks. <br /> � Yes o No <br />