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TestAmeriSan Francisco �� estA l eric .A <br /> 1220 Quarry Lanene Chain of Custody Record ll <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600.3002 ' `t MA. „ <br /> Sampler Lab PM: Carrier Tracking No(s). COC No. <br /> Client Information (Sub Contract Lab) Sharma, Dimple 720-9614.1 <br /> Client Contact Phone: E-Mail: Page. <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job 9. <br /> KIFF Analytical Anal sis Requested 720-29639-1 <br /> Address: Due Date Requested: <br /> Preservation Codes: <br /> 2795 Second Street,Suite 300, 8/12/2010 A-HCL M-Hexane <br /> City TAT Requested(days): <br /> � B-NaOH N-None <br /> Davis�Ip �. C-Zn Acetate O-AsNa02 <br /> `• D-Nitric Acid P-Na204S <br /> CA,95616 ' E-NaHSO4 Q-Na2SC3 <br /> Phone: PO#. F-McOH R-Na2S2SO3 <br /> a _,a;, G-Amchlor S-H2SO4 <br /> v �` H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email WO#: n I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> Project Name: Project#: *. K-EDTA W-ph 4-5 <br /> Nestle-Ripon 72000256 p € L-EDA Z-other(specify) <br /> Site. SSOW#: _ Other: <br /> H <br /> Sample Matrix F <br /> Type (W-water, 0 a <br /> s-:ona <br /> Sample (C comp, <br /> to Sam Ie Identification-Client ID Lab ID Sam le Date Time G rab) ern .a no-) u�i Special Instructions/Note: <br /> iqge• f l $ t1E Ctscl �e 6 � gymg p ya <br /> �_ :1& �h ' . <br /> MW-3(720-29639-1) 7/29/10 08:15P if Water X f <br /> W MW-7(720-29639-2) 7/29/10 Pacific <br /> Water X <br /> O <br /> H' MW-9(720-29639-3) 7/29/10 I08 Ifo Water X <br /> ~ 07:34 <br /> to MW-10(720-29639-4) 7/29/10 Water X `f <br /> Pacific s ma <br /> MW-18(720-29639-5) 7129/10 P8:05 Water X <br /> acific tie, <br /> MW-16(720-29639-6) 7/29/10 I07'Ifo Water X G L <br /> TB-072910(720-29639-7) 7/29/10 06:52 Water X <br /> Pacific <br /> „ <br /> v a;:x <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> O Non-Hazard =Flammable Skin Irritant Poison 8 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 /> w Empty Kit Relinquished by: Date: Time: Method of Shipment: <br /> (.Q <br /> NRelinquish y. Date i e�/` D^ Com y Received by: Date/Time. Company <br /> p Relinquished b Dat(rime: l! S Company Received by: Date Time Company <br /> W Relinquished by: Company Re Daterrime. CpZa y <br /> 240 <br /> 11 CV <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°Cand NherRe arks: <br /> A Yes A No <br />