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TestAmerica San Francisco 7�Y <br /> 1220 Quarry Lane Chain of Custody Record '51 '1 ; 1C <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking No(5): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-9510.1 <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 720-29411-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, 7/22/2010 <br /> A-HCL M-Hexane <br /> City: TAT Requested(days): �°' B-NaOH N-None <br /> Davis C-Zn Acetate O-AsNa02 <br /> State,Zip'. 5 D-Nitric Acid P-Na204S <br /> CA,95616 E 10-i'. F-McOH R-Na2S2SO3 <br /> Phone: PO N4 G-Amchlor S-H2SO4 <br /> f° H-Ascorbic Acid T-TSP Dodecahydrate <br /> v <br /> Email. WO#'. ,N I-Ice V-Acetone <br /> >. � J-DI Water V-MCAA <br /> a <br /> K-EDTA W-on 4-5 <br /> Project Name: Project#: U x� L-EDA z-other(specify) <br /> Nestle-Ripon 72000256 p <br /> Site: SSOW#: _ Other: <br /> U a <br /> i" <br /> Sample Matrix R� <br /> T (w.w,rer. O <br /> Type <br /> 0) Sample (C=comp, o-, W.11m <br /> to <br /> 4 Sam le Identification-Client ID Lab ID Sample Date Time G= rabBT-T1­a Ri S eclat Instructions/Note <br /> , * - "� ice:a n <br /> ~ 12:05 <br /> 1 5725 HALL 2009-130/1900(720-29411-1) 7/20/10 Water X U� <br /> Pacific <br /> 1 5725 HALL 2009-130/2450(720-29411-2) 7/20/10 P3 Pacific Water X � pt- <br /> I <br /> 4P <br /> 11 71 1 <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 Retum To Client O Disposal By Lab Archive For Months <br /> Deliverable Requested: I,II, III,IV,Other(specify) Special InstructionslQC Requirements: <br /> CQJ <br /> Empty Kit Relin by: D Time: Method of shipment <br /> r�1 Relinquished by: // Datelfinne:` r� Company Received Daterfime. Company <br /> D Relinquished by: Daterrime: Company Received by: Daten"ime: Company <br /> ~ Relinquished by: Date/Time: Company Re d Date V eIll '. <br /> O <br /> IP <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperatures)°C and Other Remarks. <br /> A Yes A No <br />