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TestAmerica San Francisco "Fe- StAmedca <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA945661 . - <br /> Phone(9251484-1919 Fax(925)600-3002 A 3 0 0 <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma, Dimple 720-9731.1 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.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 /> 17461 Derian Ave, Suite 100, 8i254281 a P—Z-3-Zo( 0 A-HCL M-Hexane <br /> City: ` TAT Requested(days): " B-NaOH N-None <br /> Irvine op C-Zn Acetate 0-AsNa02 <br /> D-Nitric d <br /> State,Zip: N E-NaHSO4Q-Na2SSO3 <br /> CA,92614-5817 :° F-McOH R-Na2S2SO3 <br /> Phone: PO#: % N G-Amchlor S-H2SO4 <br /> 949-261-1022(Tel) 949-261-1228(Fax) pp v H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: Z" > I-Ice U-Acetone <br /> q w J-Dl Water V-MCAA <br /> Project#: K-EDTA W-ph 4-5 <br /> Project Name: <br /> Nestle-Ripon 72000256 b o L-EDA Z-other(specify)Site: SSOW#: � <br /> N � Other: <br /> �q w <br /> w7 U U Q <br /> Sample <br /> Matrix <br /> Type (w.w:cep, x o o <br /> iz <br /> Zf <br /> Sample (C Comp, os oe n j j 1 <br /> Sample Identification-Client ID Lab ID Sample Date Time G rab) BT Ti AAI u m m i- Special Instructions/Note <br /> 13 todX g .. . <br /> 5725 HALL 2009 INF(720-29897-2) 8/12/10 09:50 Water X X �3 <br /> Pacific <br /> wog <br /> .' <br /> a*. <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> O Non-Hazard 0 Flammable Skin Irritant 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 /> Relinquished by: /� Daterrime: �/ Company Received by: �+ Dat n Company <br /> llj <br /> Relinquished by: Daterrime: Company Received by: Dat ime: Company <br /> Relinquished by: Date/Time: Company Received by: Date/Time: Company <br /> Custody Seals Intact: Custody Seal No.: Page 40 of 4 peCoolerTemrature(s)°C and Other Remarks: <br /> �j <br /> A Yes D No <br />