Laserfiche WebLink
TestAmerica San Francisco 7q 1 � 0 TestAmerica <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 "IF i. "." <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Samples Lab PM: Carrier Tracking No(s). COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-9738.1 <br /> Client Contact: Phone. E-Mail: Page. <br /> Shipping/Receiving dimple.stiarma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Analysis Requested 720-29903-1 <br /> Address: Due Date Requested: '°'?"Preservation Codes: <br /> 2795 Second Street, Suite 300, 8/25/2010 A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Davis C-Zn Acetate O-AsNa02 <br /> D-Nitric Acid P-Na204S <br /> State,Zip E-NaHSC4 Q-Na2S03 <br /> CA,95616 F-McOH R-Na2S2SO3 <br /> Phone: <br /> PO#: G-Amchlor S-H2SO4 <br /> N " H-Ascorbic Acid T-TSP Dodecahytlrate <br /> Email: WO#: n e I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> K-EDTA W-ph 4-5 <br /> Project Name: Project#: Es <br /> L-EDA Z-otther(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site, SSOW# Other: <br /> H <br /> 4 <br /> Sample Matrix F <br /> p z <br /> Type 0 <br /> ra Sample (C=comp, os so+d v <br /> Nlons/Not <br /> :.ron j e <br /> tq Sam le Identification-Client ID Lab ID Sample Date Time G rab e.n u.,A-Ak V) Special InstructEtp <br /> », e.� xa��:. A- ..:.�,,.. o- " ",,�a, ..» R °v .. ''...?a, <br /> 'r... , <br /> 4, <br /> 0 5725 HALL 2009 EFF(720-29903-1) 8/12/10 P9.3f Water X x <br /> 0t 5725 HALL 2009 MID(720-29903-2) 8/12/10 P fi 09:43 Water X '0 2 <br /> 5725 HALL 2009 INF(720-29903-3) 8/12/10 09:50 Water X 0� <br /> N <br /> Pacific <br /> TB-081010(720-29903-4) 8/12/10 P07:45 <br /> Water X Q <br /> qs�f <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> = Non-Hazard O Flammable Skin Irritant Poison B Unknown Radiological I 0 Retum To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested: I, II, III, IV,Other(specify) Special Instructions/QC Requirements: <br /> >y Method of Shipment. <br /> Empty Kit Relinquished by: Date: Time: <br /> (D <br /> iD Relinquished by: r Date/Time: / / Company Received by. DateMme. Company <br /> O <br /> Relinquished by Date/Time: Co pany Received by Company <br /> CD <br /> Relinquished by: Date/Time: Company Re d by: �( 1 re 10 om an <br /> 1603 <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature( and Other Remarks. <br /> A Yes A No <br />