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TestAmerica San Francisco 7626? <br /> 1220 Quarry Lane Chain of Custody Record Tefiria <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-11106.1 <br /> Client Contact: Phone: E-Mail* Page: <br /> Shipping/Receiving Idinn e-sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Analysis Requested 720-33129-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, 2/11/2011 <br /> A-HCl M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> State,Zip: A D-Nitric Acid P-Na204S <br /> CA,95616 ;l E-NaHSO4 Q-Na2SO3 <br /> F-McOH R-Na2S2SO3 <br /> Phone: PO#: <br /> • � G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email'. WO#: Z ,;;,,,,;;, U) <br /> I-Ice U-Acetone <br /> 4 .G;, J-DI Water V-MCAA <br /> n' m7" a <br /> Project Name: Project#: m d K-EDTA W-ph 4-5 <br /> ,.. U w L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 m a 0 15 <br /> Situ. SSOW#: E� u',Other: <br /> o <br /> Sample Matrix � a' <br /> Type (w=w .w. o z <br /> YP s=so,d p° U <br /> Sample (C=comp, o_wdst� „ 32 m r' <br /> m ". <br /> Sample Identification-Client ID Lab ID Sample Date Time G= rab) eT=To:�e a a e- tt°i=, to Special Instructions/Note: <br /> _U Preservation Code: <br /> 10:45 <br /> (Q TB-012811 (720-33129-1) 1/28/11 Water X ' ;Z <br /> (D Pacific <br /> OD 5724 HALL(720-33129-2) 1/28/11 11.58 Water X 3' L <br /> p Pacific <br /> O <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> l--]Non-Hazard =Flammable Skin Irritant Poison B Unknown Radiological =Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV,Other(specify) Special Instructions=Requirements: <br /> -D Empty Kit Rel' ed by: Date: Time: Method of shipment: <br /> v <br /> (.0 RelmquisD m <br /> (D Co ny Received by Date/Time: C ny <br /> IV Relinquished by Date/Time Company Received by. Date/Time Com an <br /> O <br /> 00 00 O Relinquished by: Date/Time. Com n Date/Time. ��� Company <br /> � <br /> 6 I <br /> Custody Seals Intact: CUStOdy Seal NO.: Cooler Temperature(s)°C and Other Remarks: <br /> A Yes A No <br />