Laserfiche WebLink
TestAmerica San Francisco � 5� ����� <br /> 1220 Quarry Lane Chain of Custody Record I��' <br /> Pleasanton, CA 94566 <br /> Ll+i'Sr: h TA, <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 720-9768.1 <br /> Client Contact Phone E-Mail: Page. <br /> Shipping/Receiving I dimple,sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Anal sis Requested 720-29975-1 <br /> Address: Due Date Requested: ' ^A Preservation Codes: <br /> 2795 Second Street,Suite 300, 8/31/2010 g" <br /> A-HCL M-Hexane <br /> City. TAT Requested(days): '; s B-NaOH N-None <br /> Davis C-Zn Acetate 0-ASNa02 <br /> State,Zip'. D-Nitric Acid P-Na204S <br /> CA,95616 T- E-NaHSO4 0-Na2S03 <br /> .T6„ F-McOH R-Na2S2S03 <br /> Phone: PO#: «» <br /> - G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: N , 1-Ice U-Acetone <br /> s J-DI Water V-MCAA <br /> Project Name: Project#: rn $ K-EDTA W-ph 4-5 <br /> U L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site. SSOW#. Z Other: <br /> i= <br /> U <br /> Sample Matrix <br /> Type (W-4t." � O <br /> I'd Sample (C=Comp, o•w..a.�n j <br /> N Sam le Identification-Client ID Lab ID Sample Date Time G= rab BT•Tbaue,A•Alr N Special Instructions/Note: <br /> Y� r. <br /> 00 5725 HALL 2009 INF(720-29975-1) 8/17/10 13:29 Water X <br /> Pacific <br /> O 13:45 d <br /> 1-h TB-081710(720-29975-2) 8/17/10 Pacific Water X <br /> 0 <br /> , F <br /> r; <br /> �m <br /> �az <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =Non-Hazard 0 Flammable Skin Irritant Poison B Unknown Radiological 0 Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I, ll,III, IV,Other(specify) Special Instructions/QC Requirements: <br /> v Empty Kit Relinquished by: Date: Time: P <br /> Method of Shipment <br /> (Q <br /> (D Relin is y. Dat im Com an Received by: DatelTime: Company <br /> Fifa 13'10 <br /> O Relinquish d y. DaterTime: Company Received by: ime. Company <br /> 0 <br /> Relinquished by Daterrime: Company R ive Dateriime. Cm <br /> (eil o Lo 41 <br /> Custody Seals Intact: Custody Seal No.: cooler perature(s)°C and other Remarks. <br /> 0 Yes 0 No <br />