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TestAmerica San Francisco .� <br /> 1220 Quarry Lane Chain of CustodyRecord <br /> Pleasanton, CA 94566 <br /> THE LEADER W E$NY1l7ONMENTAL TES,TWG <br /> Phone 925 484-1919 Fax 925)600-3002 <br /> Sampler: 11ab PM: Carder Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-5025.1 <br /> Client Contact: Phone: E-Mail: - Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: - Job#: <br /> TestAmerica Laboratories,Inc. Analysis Re nested 720-19656-1 <br /> Address: Due Date Requested: <br /> Preservation Codes: <br /> 4101 Shuffel Street NW, 5/19/2009 A-HCI- M-Hexane <br /> TAT Requested(days): B-NaOH N-None <br /> M <br /> C-Zn Acetate O-AsNaO2 <br /> ate,Zip: _ - D-Nitric Acid. P.-Na2O4S <br /> OH,44720 E-NaHSO4 Q-Na2SO3 <br /> Phone: PO <br /> F-MeOH R-Na2S2SO3 <br /> #: G-Amchlor S-H2SO4 <br /> 330497-9396(Tel) 330-497-0772(F2X) a H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email WO#: _ I-Ice U-Acetone <br /> —y J-DI Water V-MCAA <br /> Project Name: Project#: J K-EDTA W-ph 4-5 <br /> Nestle-Ripon 72000256 3 I--EDA Z-other(specify) <br /> Site: SSOW#: J Other: <br /> H <br /> V <br /> a <br /> Sample Matrix <br /> Type (w=..w ZO <br /> s_soud, <br /> Sample (C=comp, o_sts/o0. m <br /> Sample Identification-Client ID tab ID Sample Date Time G rab) BT=Ti W,A­-Air) r=A Special Instructions/Note: <br /> Saw= MEN4a O <br /> 0 <br /> E2&E6EFF(720-19656-1) 5/5/09 15:38 Water X oo o <br /> r-1 0 <br /> EU3&EU4EFF(720-19656-3) 5/5/09 15:05 Water X <br /> Zs <br /> ro <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 8 Unknown Radiological =Return To Client = Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV,Other(specify) Special Instructions/QC Requirements: <br /> Empty Kit Relinquished PyA Date: Time: Method of Shipment. <br /> Relinquished by: D to e: �� Comp ny Received by: Date i Com <br /> Oct— <br /> Relinquished by: Datfirimel Company Received b r Datemme: Company <br /> E <br /> hed by: Date/rime: Company Received by: Date/rime: Company <br /> dy Seals Intact: CustodySea]No.: t>: Cooler Temperature(s)°Cand Other RemarksYes A No' <br />