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TestAmerica San Francisco t om► TestAmeric 1 <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 :at,ray Fa n�:nvznz.r ar-.TF->; 3tz,KCs <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Career Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-11123.2 <br /> Client Contact: Phone: E-Mail: Page. <br /> Shipping/Receiving I dimple.sharma@testamericainc.com Page 2 of 2 <br /> Job#: <br /> Company: <br /> KIFF Analytical Analysis Requested 720-33172-1 <br /> Address. Due Date Requested: a �£,Preservation Codes: <br /> 2795 Second Street,Suite 300, 2/15/2011 ; A-HCL M-Hexane <br /> City. TAT Requested(days): af•, B•NaOH N-None <br /> tate 0-AsNa02 <br /> Davis C-Zn Ace <br /> - D-Nitric Acid P-Na204S <br /> State,Zip: gy' E-NaHSO4 Q-Na2SO3 <br /> CA,95616 F-McOH R-Na2S2SO3 <br /> Phone: PO#: :"a G-Amchlor S-H2SO4 <br /> spa H-Ascorbic Acid T-TSP Dodecahydrate <br /> I-Ice U-Acetone <br /> Email. WO# '+. T J-DI Water V-MCAA <br /> K-EDTA W-ph 4-5 <br /> Project Name: Project#: ` U L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 i '.'other: <br /> Site: SSO W#: . <br /> U <br /> Sample Matrix <br /> Type <br /> 0 <br /> (w- a., e <br /> Sample (C=Comp ogwa t�a V' IM <br /> Sample Identification-Client ID Lab ID Sam le Date Time G= rab a,.s AAI <br /> `� <br /> Special <br /> fir.. <br /> _P� 7717 KIERNAN(720-33172-17) 2/1/11 <br /> P 5.05 Water X F <br /> 00 1 Z, <br /> p 13:39 Water <br /> 1 J <br /> 1051 ROBERT(720-33172-18) 2/1/11 Pacific <br /> ch! <br /> oe; <br /> p <br /> 46sq:;: <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 =Return To Client 0 Disposal By Lab Archive For Months <br /> v Deliverable Requested:I,II,III, IV,Other(specify) Special Instructions/QC Requirements: <br /> rQ <br /> (D Method of Shipment. <br /> N Empty Kit Relinquished by: Date: Time: <br /> O C> DateRime Company Recby <br /> N Relingfished by. Daty/ti Co apy <br /> 02�3— 1 1110 TT <br /> N Relin ed by: Daterr e Company Received by: Date/Time: Co <br /> N <br /> C3 Datell-ime Compan <br /> Relinquished by: Date/7ime: Company Received by: P <br /> 2S�f /e <br /> Custody Seals Intact: Custody Seal No.: Cooter Temperatures)°C and Other Remarks: <br /> A Yes A No <br />