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TestAmerica San Francisco � t, �,P Test �.� <br /> 1220 Quarry Lane Chain of Custody Record /-/ <br /> Pleasanton, CA 94566 <br /> r ,-., <br /> . <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM. Carder TrackingNo(s): COC No. <br /> Client Information (Sub Contract Lab) Sharma, Dimple 720-9893.1 <br /> Client Contact Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Anal sis Requested 720-30300-1 <br /> Address: Due Date Requested: .r'"',Preservation Codes: <br /> 2795 Second Street, Suite 300, 9/17/2010 <br /> A-HCL M-Hexane <br /> City: TAT Requested(days): CU B-i N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> Zip: D-Nitric Acid P-iState,Z <br /> CA,9 ip: E-Nal 0-i" F-i R-Na2S2S03 <br /> Phone: PO#: G-Amchlor S-H2SO4 <br /> Cl! H-Ascorbic Acid T-TSP Dodecahydrate <br /> v . U-Acetone <br /> Email: WO#: w '�':. I-Ice <br /> F J-DI Water V-MCAA <br /> K-EDTA W-ph 4-5 <br /> Project Name: Project#: � <br /> O L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 <br /> Site: SSOW#: _ Other: <br /> U 3i <br /> Sample Matrix <br /> Type (WW�, p <br /> YP - . 1 <br /> I'd Sample (C=comp, o-w..nmu <br /> W Samle Identification-Client ID Lab ID Sample Date Time G= rab 9T-T1 6ue,A-Air ' N Special Instructions/Note: <br /> UQ e6, <br /> 00 5725 HALL 2009 INF(720-30300-1) 8/31/10 12'12 Water X (� <br /> P ifi <br /> TB-083110(720-30300-2) 8/31/10 F9'Ifi Water X ©Z <br /> o <br /> S <br /> VU] <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =Non-Hazard =Flammable Skin Imtant 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 /> Method of Shipment: <br /> v Empty Kit Relinquished by: Date: Time: P <br /> (D Relinquished by Date/TiVitCompany Received /rime: Company <br /> Relinquished by: Datelrime: Company Received by: Date/Time: _ <br /> 00 <br /> R linquished by: Dalelfimen /I��� Company, - <br /> oglC �(1 <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperatures)°C and Other Remarks: <br /> A Yes o No <br />