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TestAmerica San Francisco Test+"'"cl`Y erica <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: Carrier Tracking No(s): COC No: <br /> 10 <br /> Client Information (Sub Contract Lab) sharma,Dimple 917.1 <br /> Page: <br /> Client Contact: Phone: E-Mail: Page, <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 2 <br /> Job#: <br /> Company: Anal is Requested 720-32620-1 <br /> KIFF Analytical <br /> Preservation Codes: <br /> Address: Due Date Requested: <br /> 2795 Second Street,Suite 300, 1/18/2011 A-HCL M-Hexane <br /> O <br /> City: TAT Requested(days): C-Zn Acetate O-AsNs02 <br /> Davis D-Nitric Acid P-Na204S <br /> State,Zip: E-NaHSO4 Q-Na2S03 <br /> CA,95616 ;,; F-McOH R-Na2S2S03 <br /> Phone: PO#: a G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> ,N I-Ice U-Acetone <br /> WO#: <br /> Email: J-DI Water V-MCAA <br /> a K-EDTA W-ph 4-5 <br /> Project Name: Project#: L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 > Other: <br /> Site SSOW#: F <br /> U <br /> Sample Matrix <br /> Type (w•w.nr, p <br /> s -a ud, ,. U <br /> Sample (C=comp, o-w.w,ii, m <br /> Sam le Identification-Client ID Lab 11011 Sample Date Time G= rab) ST-Tissue,A•mr special InstructlonslNote <br /> 16:00 la <br /> CD ;;qq.. <br /> N TB-010411 (720-32620-2) 1/4/11 Water X V <br /> P ifi <br /> 0 7501 KIERNAN 2008 MID(720-32620-7) 1/4/11 17-00 Water X o2 <br /> � Pacfic <br /> O7501 KIERNAN 2008 INF(720-32620-8) 1/4/11 17'02 Water X <br /> a ifi L�- <br /> X " I <br /> 5725 HALL 2009 EFF(720-32620-9) 114111 16:12 Water <br /> 5725 HALL 2009 MID(720-32620-10) 114111 Pacific <br /> fiWater X <br /> Pacific <br /> 5725 HALL 2009 INF(720-32620-11) 1/4/11 16.18 Water X 06 <br /> Pacific <br /> 802 VERA EFF(720-32620-12) 1/4/11 1612 Water X 0 <br /> Pacific <br /> r�R <br /> 802 VERA MID(720-32620-13) 114111 16'14 Water X t/ <br /> Pairific <br /> 802 VERA INF(720-32620-14) 1/4/11 16.18 Water X <br /> PAnifir <br /> 7501 KIERNAN 2008 EFF(720-32620-15) 114111 16.57 Water X 0 <br /> Pacific <br /> RC-1 (720-32620-16) 1/4111 15:00 Water X <br /> Possible Hazard Identification Pacific Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Non-Hazard =Flammable O Skin Irritant Poison B 0 Unknown Radiological O Return To Client O Disposal By Lab Archive For Months <br /> w Deliverable Requested:I,ll, III, IV,Other(specify) Special Instructions/QC Requirements: <br /> Lo <br /> CD Date: Time: Method of Shipment. <br /> N Empty Kit Relinquished by: <br /> O W Daterrime: Compan Received by: <br /> O Date/time: Company <br /> Relinquished by. I I _ � <br /> � Date/Time: Company <br /> K) Relinquished by: Daterrime: Company Received by: <br /> O Daterrime: Company Received by: Daterrime: 2 Company <br /> Relinquished by: d-I-A 4-t 1)4,ea t <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s) C and Omer Remarks. <br /> A Yes o IN <br />