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TestAmerica San Francisco �(� 2G] �l "r'��� ��-��� <br /> 1220 Quarry Lane Chain of Custody Record L ( 7 1 <br /> Pleasanton, CA 94566 ;4r, .'AOY£q ih .JViR,:<ra4at€t <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 720-9829.1 <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 720-30087-1 <br /> Address. Due Date Requested: s Preservation Codes: <br /> 2795 Second Street, Suite 300, 9/8/2010 <br /> A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Davis - C-Zn Acetate O-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> CA,95616E-NaHSO4 0-Na2S03 <br /> F-McOH R-Na2S2SC3 <br /> Phone: PO#: <br /> Ci G-Amchlor S-H2SO4 <br /> v H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: sx` n -Ice U-Acetone <br /> -t+ r J-DI Water V-MCAA <br /> n K-EDTA W-ph 4-5 <br /> N <br /> Project Name, Project#: U =. L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site. SSOW#: _ ,:'..Other: <br /> U <br /> U <br /> K <br /> Sample Matrix � <br /> Type (W-wars, 0 <br /> YP s-aouc U <br /> b Sample (C—comp o aavr g m <br /> LQ Sam le Identification-Client ID Lab ID Sample Date Time G rab BT n ..,A-Ao- N Special Instructions/Note: <br /> N z argn" e <br /> F <br /> ;a <br /> N 7501 KIERNAN 2008 EFF(720-30087-1) 8/24/10 P15:06 Water Xic I <br /> D 7501 KIERNAN 2008 MID(720-30087-2) 8/24/10 15:08 Water X QZ <br /> Hh P if <br /> N 5725 HALL 2009 EFF(720-30087-3) 8/24/10 14:50 Water X 03 <br /> p <br /> Pacific <br /> 5725 HALL 2009 MID(720-30087-4) 8/24/10 14:52 Water XPacific 04 <br /> 5725 HALL 2009 INF(720-30087-5) 8/24/10 14:54 Water X Q5 <br /> Pacific <br /> TB-082410(720-30087-6) 8124/10 Pacific <br /> Water X J6 <br /> f <br /> P ifi <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =Non-Hazard =Flammable Skin Irritant Poison B Unknown Radiological =Retum To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested: I, II, III, IV,Other(specify) Special Instructions/QC Requirements: <br /> v <br /> Empty Kit Relinqui Date: Time: Method of Shipment. <br /> Relinquished /by: ` Da e: Company _ Received b: Date/Time: Company 1�( 2 - <br /> Relinquished by: Date/Time: Company Received by: Date[Tim . mpany <br /> N <br /> Relinquish by: Daterii mpa Re by: e e omp y <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperatures)"Cand Other Remarks: <br /> A Yes o No <br />