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TestAmerica San Francisco <br /> 1220 Quarry Lane Chain of Custody Record TestAmedca <br /> Pleasanton, CA 94566 ,xl=slt tttr�aa°a=+�+a � rs= xf�a=;a <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 720-9732.1 <br /> Client Contact Phone: E-Mail: Page: <br /> Shipp!nglReceiving idimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> TestAmerica Laboratories, Inc. Analysis Requested 720-29897-1 <br /> Address' Due Date Requested: Preservation Codes: <br /> 4101 Shuffel Street NW, a�2 � F` 3'-Z(:-`( A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaCH N-None <br /> North Canton C-Zr acetate 0-AsNa02 <br /> D-Nitric Acid P-N2204S <br /> State,Zip: E-NaHSO4 0-Na2SO3 <br /> OH,44720 F-MeOH R-Na2S2SO3 <br /> Phone' PO#' s. G-AmchEar S-H2SO4 <br /> 330-497-9396(Tel) 330-497-0772(Fax) H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email <br /> WO#: = 1-Ice U-Acetone <br /> m J-DI Water V-MCAA <br /> m <br /> Project Name: K-EDTA W-ph 4-5 <br /> Project#: J <br /> L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site: <br /> SSCW#: Other: <br /> V <br /> Sample Matrix <br /> Type (W-water, O <br /> 8­11d 0 <br /> Sample (C=comp, o=weswoil, m <br /> Sam le Identification-Client ID tab ID) Sample Date Time G=grab) BT•Tlssue,A•Alr W Special Instructions/Note: <br /> SAM <br /> 5725 HALL 2009 INF(720-29897-2) 8112110 09:50 Water X 4 rn <br /> co <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =1 Non-Hazard =Flammable ©Skin Irritant Poison B Unknown Radiological ©Return To Client 1:1 Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II, III, IV,Other(specify) Special Instructions/QC Requirements: <br /> Empty Kit Relinquished by'. IDate: Time: IMethod of shipment <br /> Relinquished by. Date[ffi�me:: Compan Received by: DatelTime. Company <br /> Relinquished by: Datefrime: Company Received by: Datelfime, Company <br /> Relinquished by: Oatelfima: Company Received by: Daterrime: Company <br /> i5eal oa's. ...... ..;r Cooler iempetatuie(s}"C and Cltrer Remarl s <br /> Custody Seals lntact Custody` N <br /> No -":' <br />