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TestArnerica San Francisco -B W-3 Tes 1 Merica <br /> 1220 Quarry Lane <br /> Pleasanton, CA 94566 Chain of Custody Record <br /> Plea <br /> Phone(925)484-1919 Fax(925)600-3002 r .Erb> zt €:sacra z;r t4t .,s t.sx+trn <br /> Sampler Lab PM. Carrier Tracking No(s), 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 Analysis Requested 720-29412-1 <br /> Address. Due Date Requested: .F Preservation Codes: <br /> 2795 Second Street,Suite 300, 8/3/2010 , <br /> N; A-HCL M-Hexane <br /> City: TAT Requested(days): - "�; B-NaOH N-None <br /> Davis s C-Zn Acetate O-AsNaC2 <br /> State,Zip. ' D-Nitric Acid P-Na2045 <br /> CA,95616 i E-NaHSO4 Q-Na2SO3 <br /> Phone, PO#; `; F-McOH R-Na2S2SO3 <br /> w G-Amchlor S-H2SO4 <br /> e " H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email WO#: <br /> I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> a <br /> Project Name. Project#: m `. K-EDTA W-ph 4-5 <br /> Nestle-Ripon72000256 p A L-EDA Z-other(specify) <br /> Site: SSOW#: _ � <br /> k Other: <br /> F <br /> U <br /> Sample Matrix <br /> Type (w-w.r.r, ZO <br /> s-.alaCl <br /> Sam Ie Identification Client ID Lab ID Sample Date <br /> Sample <br /> G=crab erorlaurBA-Air rn <br /> I' ron, CIO <br /> d AM Special Instructions/Note:+..f.; <br /> -a e,,° M" T" _ - <br /> „ �.r <br /> 7501 KIERNAN 20086 EFF(720-29412-1) 7120/10 14 49 Water X <br /> tD Pacific a <br /> D 7501 KIERNAN 2008 MID(720-29412-2) 7/20110 14:59Pacific <br /> Water X � <br /> F, TB-072010(720-29412-3) 7/21110 10:20 Water X <br /> F, <br /> Pacific <br /> N <br /> � 6 <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than f month) <br /> =Non-Hazard =Flammable Skin/rntant Poison B Unknown Radiological =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 /> Relin uis <br /> (� q D�atyelTime: Coma Received by; Daterrime, Com a <br /> Relinquished by: D to ime: - /D Company Received b <br /> _ pyY Y Date/7ime. Company <br /> Relinquished by: Daterrime: Company-F Re ved Da <br /> c .rly 5 av <br /> Custod Seals Intact: Custody Seal N <br /> y y o.: Cooler Te eralure(s)°C and Other Remarks: <br /> A Yes o No <br />