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TestAmerica San Francisco /O 1 v 3 <br /> 1220 Quarry LaneChain of Custody Record TestAmedca <br /> Pleasanton, CA 94566 ",¢ a ra;,i . •r ,e trraeee wtr , -€•a;, <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler, Lab PM: Carder Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-11055.2 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 2 of 2 <br /> Company: Job W: <br /> KIFF Analytical Analysis Requested 720-32943-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, 2/2/2011 <br /> .. A-HCL M-Hexane <br /> City: TAT Requested(days): .v B-NaOH N-None <br /> Davis : C-Zn Acetate 0-AsNa02 <br /> State,Zip, - D-Nitric Acid P-Na204S <br /> CA,95616 . E-NaHSO4 Q-Na2SO3 <br /> r;'. F-MeOH R-Na2S2SO3 <br /> Phone: PO#: z a G-Amchlor S-H2SO4 <br /> N <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> Project Name: Project#: K-EDTA W-ph 4-5 <br /> Nestle-Ripon 72000256 p L-EDA Z-other(specify) <br /> Site: SSOW#: "s - _ to Other: <br /> U <br /> Sample Matrix <br /> Type (W—W. z0 <br /> s na <br /> Sample (C=comp o-w emu m " <br /> Sam le Identification-Client ID Lab ID Sample Date Time G=grab) 3T-n: A-no-) r ti Special Instructions/Note: <br /> ' - ., ..• are a>ra <br /> MW-18(720-32943-12) 1/20/11 07:49f Water X /Z <br /> W <br /> � <br /> MW-9(720-32943-13) 1/20!11 Pa:00 Water X <br /> 3 <br /> co "PJa <br /> ,A <br /> �A3 <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =1 Non-Hazard 1___1 Flammable Skin Irritant Poison B Unknown Radiological =Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I,ll,III,IV,Other(specify) Special InstructionslQC Requirements: <br /> v <br /> CD Empty Kit Relinquished by: Date: Time: P <br /> Method of Shipment: <br /> Relinquished by: Daterrime. Company Received by: Daterrime: Company <br /> Relinquished by: Daterrime. Cornom an <br /> IV <br /> O <br /> IV <br /> Relinquished by: Date(Time: Re ived by: Daterl-Imei Company <br /> IJ— K <br /> Custody Seals Intact: Custody Seal No.: Cooler tempera re(s)°C and Other Remarks: <br /> A Yes A No <br />