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TestAmerica San Francisco 7_S_ I S :�L !estA m it ica <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 a.,;, r,> .,°xi>i,.r'•r � ' ,,.,,c <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler Lab PM: Camer Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-10917.2 <br /> Client Contact: Phone: E-Mail: Page: <br /> ShippinglReceiving dimple.sharma@testamericainc.com Page 2 of 2 <br /> Job#: <br /> Company, <br /> KIFFAnalytical Anal sis Requested 720-32620-1 <br /> Address: Due Date Requested: " Preservation Codes: <br /> 2795 Second Street,Suite 300, 1/18/2011 A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> C-Zn Acetate 0-AsNa02 <br /> Davis <br /> '" D-Nitric Acid P-Na204S <br /> State,Zip: E-NaHSO4 Q-Na2SO3 <br /> CA,95616 F-McOH R-Na2S2SO3 <br /> Phone: PO#: G-Amchlor S-H2SO4 <br /> �'. H-Ascorbic Acid T-TSP Dodecahydrate <br /> r I-Ice U-Acetone <br /> Email: WO#: <br /> J-DI Water V-MCAA <br /> a K-EDTA W-ph 4-5 <br /> Project Name: Project#: tj L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 <br /> Other: <br /> Site: SSOW#: <br /> F <br /> U <br /> Sample Matrix <br /> Type <br /> (W-water, O <br /> Sample (C=comp osw,won m <br /> - Sam le Identification Client ID Lab ID Sample Date Time G=grab) ar ne.0A-Ai, w I I I Special�e< A <br /> a ns ruc Ions o e <br /> CD 7717 KIERNAN(720-32620-17) 1/4/11 16'37 Water X 1 Z <br /> (Jr! Pacific <br /> w 1644 <br /> O 7969 KIERNAN(720-32620-18) 1/4/11 Pacific <br /> Water X <br /> Cr) 7971 KIERNAN(720-32620-19) 1/4/11 Pacfi Water X W <br /> 1051 ROBERT(720-32620-20) 114/11 16:00 Water X I <br /> Pacific <br /> / <br /> I 10 MANLEY(720-32620-2 1) 1/4/11 16:40 Water X �b <br /> Pacific <br /> 361 PARALLEL(720-32620-22) 1/4111 16:30 Water X <br /> P ifi <br /> a <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 Return To Client Dis osal By Lab Archive For Months <br /> v Deliverable Requested:I,II,III,IV,Other(specify) Special Instructions=Requirements: <br /> cD Empty Kit Relinquished by: Date: Time: Method of shipment. <br /> N DatefTime: Company <br /> C) A Relinquished by: Date/Time: Comp Received by: <br /> o NAA <br /> C ( - - i - d <br /> N N Relinquished by: Daterrime: Company Received by: Daterrime: Com an <br /> � CJt <br /> N <br /> � Relinquished by. Date/Time: Company Received by: Date/Time Com n <br /> oiosr/ /63- �.lR► « <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: <br /> A Yes A No <br />