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TestAmerica San Francisco ?6 /g i <br /> ca <br /> 1220 Quarry Lane Chain of Custody Record ' s <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: CamerTracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-11055.1 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 2 <br /> Company: Job#: <br /> KIFF Analytical Anal sis Requested 720-32943-1 <br /> Address: Due Date Requested: " Preservation Codes: <br /> 2795 Second Street,Suite 300, 212/2011 A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Davis <:; C-Zn Acetate 0-AsNa02 <br /> D-Nitric Acid P-Na204S <br /> State,Zip: <br /> E-NaHSO4 Q-Na2S03 <br /> CA,95616 -": F-McOH R-Na2S2S03 <br /> Phone: PO#: G-Amchlor S-H2SO4 <br /> N <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: h I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> X1 <br /> A <br /> Project Name: Project#: U L-EDAZ-other (specify) <br /> Nestle-Ripon 72000256 0 <br /> Site: SSOW#: _ M1 Other: <br /> F- r <br /> U <br /> Sample Matrix <br /> Type 0 <br /> Sample (Cmc omp o.w,to u m <br /> Sam le Identification-Client ID Lab ID Sample Date Time G=grab) sT-ns. ani N <br /> Special Instructions/Note <br /> a a.,vt .. _ E .,r« Y'i' `�•` 3f ` , x "," ate.:a" «, 7 .ea , <br /> O 7501 KIERNAN 2008 EFF(720-32943-1) 1/18/11 14'14 Water X <br /> W <br /> Pacific <br /> p7501 KIERNAN 2008 MID(720-32943-2) 1/18/11 Pacific4'17 Water X <br /> W 5725 HALL 2009 EFF(720-32943-3) 1/18111 P3'IfO Water X <br /> 5725 HALL 2009 MID(720-32943-4) 1/18111 Pacific <br /> Water X O <br /> P ifi ° <br /> 802 VERA EFF(720-32943-5) 1/18111 P4'fi Water X <br /> 802 VERA MID(720-32943-6) 1/18/11 14.58 Water X <br /> Pacific <br /> 5:05 � <br /> TB-011811 (720-32943-7) 1/18/11 11ifi Water XPacres r J <br /> MW-3(720-32943-8) 1/20/11 08:27 WaterPacific <br /> X A� <br /> 21 <br /> MW-7(720-32943-9) 1/20111 Pacific ifi Water X —�7 <br /> MW-10(720-32943-10) 1/20/11 08'20 Water Xac ic <br /> —�V <br /> MW-16(720-32943-11) 1/20/11 07:36 Water X <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 0 Non-Hazard =Flammable O Skin Irritant Poison B O Unknown 0 Radiological 0 Retum To Client O Disposal By Lab Archive For Months <br /> - Deliverable Requested:I,ll,III, IV, Other(specify) Special Instructions/QC Requirements: <br /> CD Empty Kit Relinquished by: Date: Time: Method of Shipment: <br /> Op Relinquished by. \ Date rime Com any Received by: Daterrime: Company <br /> O ��. V —Z <br /> N 1200 <br /> Relinquished by: an Receivetl by: Da----e�. Company <br /> O <br /> N <br /> p Relinquished by Company Race iv b F(r Daterrime: Comp ny <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: <br /> A Yes o No <br />