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TestAmerica San Francisco 7 <br /> 3e/2 �"2 <br /> 1220 Quarry Lane Chain of Custody Record Te tAmeriCa <br /> Pleasanton, CA 94566 <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 720-9384.1 <br /> Client Contact Phone: E-MaiC Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Anal sis Requested 720-29163-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, 7/20/2010 - A-HCL M-Hexane <br /> City: TAT Requested(days): `' B-NaOH N-None <br /> Davis �'}, ', C-Zn Acetate 0-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> >< <br /> CA,95616 E-NaHSO4 0-Na2S03 <br /> F-McOH R-Na2S2SO3 <br /> Phone: PO#: �, G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TS P Dodecahydrate <br /> Email: WO#: W) ;% -Ice U-Acetone <br /> J-DI Water V-MCAA <br /> K-EDTA W-ph 4-5 <br /> Project Name: Project#: U L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site: SSOW#: _ �:Other: <br /> U <br /> Sample Matrix <br /> Type (W—w. zO <br /> ro Sample (C=comp os osa <br /> Nsnr n m <br /> Lq <br /> Sam le Identification Client ID Lab ID Sam le Date Time G=grab) 3T-TI­.,Api y Special Instructions/Note: <br /> .*�.�..,,... � �^ 'a ® "' ., �. � >• .r -. � ,. .. u .._' �� a� <br /> £: <br /> 0 7501 KIERNAN 2008 EFF(720-29163-1) 7/6/10 <br /> 15:10 ciiWater X Q' <br /> O15:12 <br /> th 7501 KIERNAN 2008 MID(720-29163-2) 716/10 P if Water X T 02 <br /> 15:15 2 <br /> W 7501 KIERNAN 2008 INF(720-29163-3) 7/6/10 Pacific Water X € w J <br /> TB-070610(720-29163-4) 716/10 14.45 Water Xt 09 <br /> Pacific <br /> " <br /> 1�$ <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 0 Non-Hazard O Flammable Skin Irritant Poison B Unknown Radiological O Retum To Client 0 Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III, IV,Other(specify) Special Instructions/QC Requirements: <br /> v <br /> am Empty Kit R by: ------- „ Date: Time: Memos of shipment: <br /> QJ <br /> Relinquished b Dtern Company Received by. Daterfime. Company <br /> Relinquis b ( Daime: Company Received by: Daterfime: Company <br /> HRelinquished by: Daterrime: Com an R ed b . Daterrimeom any I <br /> O 0-70-710 1-73 0 <br /> Custody Seals Intact: Custody Seal No.: ooler Temperature(s)°C and Other Remarks. <br /> A Yes A No <br />