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TestAmerica San Francisco ��� 3 le S+A.Me a <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Camer Tracking No($): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-11200.1 <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 720-33413-1 <br /> Address: Due Date Requested: F" Preservation Codes: <br /> 2795 Second Street,Suite 300, 3/3/2011 ° <br /> A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> »,.e. E-NaHSO4 Q-Na2SO3 <br /> CA,95616 F-McOH R-Na2S2SO3 <br /> Phone: PO#: <br /> H G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: w e E I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> Project Name: Project#: . K-EDTA W-ph 4-5 <br /> V L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site: SSOW#: _ ? Other: <br /> U <br /> Sample Matrix t <br /> Type (w-w.e.r, <br /> p <br /> s•.na <br /> Sample (C=comp o w,N., m <br /> Sample Identification Client ID Lab ID Sam le Date Time G=grab) ern.0A-An U) Special Instructions/Note: <br /> fly, <br /> all &fi 'a <br /> A ®m ® P f i sr F � �� �� o1 'R T1 . <br /> n .r.ae-, A. _ _ 777 <br /> m7501 KIERNAN 2008 EFF(720-33413-1) 2/15/11 13 08 Water X Q <br /> Pacific <br /> 7501 KIERNAN 2008 MID(720-33413-2) 2/15/11 Pacific Water Xoh OZ <br /> 5725 HALL 2009 EFF(720-33413-3) 2/15/11 13'28 Water X <br /> 0) P ific <br /> 13:30 <br /> 5725 HALL 2009 MID(720-33413-4) 2/15/11 Pacific Water X2 d <br /> 13:55 ' <br /> 802 VERA EFF(720-33413-5) 2/15/11 Water X dS <br /> Pacific <br /> 13:58 <br /> 802 VERA MID(720-33413-6) 2/15/11 P ifi Water X 06 <br /> TB-021511 (720-33413-7) 2/15/11 P4:00 Water X <br /> ;. <br /> M <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 0 Non-Hazard O Flammable Skin Irritant Poison B Unknown Radiological O Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV,Other(specify) Special Instructions/QC Requirements: <br /> v <br /> CD Empty Kit Relinquished by: Date: Time: Method of Shipment <br /> W Ref ished by, Daterii C pony Re d by: D err Chan ' <br /> w o <br /> O eli ui y: Dai Company Received by: Date/Time: Company <br /> Relinquished by: Daterrime: Company Received by: Daterri ee Z i D Company , <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)° and Other Remarks: <br /> A Yes A No <br />