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TestAmerica San Francisco <br /> 1220 Quarry Lane Chain of CustodyRecord TestAmerica <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 a 14 I tT0FR trt t4vtsacantm wrM,rs°sFWr <br /> Sampler: tab PM: Garner Tracking No(a): COC No: <br /> Client Information Sub Contract Lab Sharma,Dimple 720-4724.1 <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 Requested 720-18981-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 412212009 A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> C-Zn Acetate D-Asi <br /> State,Zip: D-Nitric Acid P-Na204S <br /> E-NaHSO4 Q-Na2S03 <br /> Phone: PO#; <br /> F-M9OH R-Na2S2SO3 <br /> 949-27U42i N G-AmchloT S-H2504 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: C11 <br /> ko <br /> I-k;e U-Acetone <br /> J-DI Water V-MCAA <br /> Project Name: Project#: m K-EDTA W ph 45 <br /> Nestle-Ripon 72000256 p L-EDA z-other(specify) <br /> sire: SSGW#: S other: <br /> a <br /> Sample Matrix <br /> Type (W., W, O <br /> 6=eolld, <br /> b Sample (C=comp, <br /> pt Sam le Identification-Client ID Lab ID) Sam le Date Time G= rab er.Tta",A-AW ai Special Instructions/Note: <br /> U <br /> tD <br /> I r 6245 CICCARELLI(720-18981-1) 417109 14:35 Water X <br /> J <br /> O 6719 CICCARELLI(720-18981-2) 417109 14:40 Water X2 <br /> 7t 1 <br /> i1 5500 HALL(720-18981-3) 4/7109 14:50 Water X <br /> 00 <br /> 7507 KIERNAN(720-18981-4) 417109 14:55 Water X I <br /> 7971 KIERNAN(720-18981-5) 417109 15:30 Water X <br /> 7961 KIERNAN(720-18981-6) 417!09 15:35 Water XE E O <br /> 8001 KIERNAN(720-18981-7) 417109 15:40 Water X P Th rm ll] /J 7 <br /> 8313 KIERNAN(720-18981-8) 417109 15:45 Water X t D8 8 /J3 <br /> 7969 KIERNAN(720-18981 9) 4/7/09 15:50 Water X <br /> OQ pr se t: e 0 9 <br /> 7957 KIERNAN(720-18981-10) 417109 15:55 Water X <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 7 month) <br /> =Non-Hazard =Flammable =1 Skin Irritant Poison B © Unknown © Radiological =Return To Client =Dis osaf By Lab Archive For Months <br /> Deliverable Requested:I,II,III, IV,Other(specify) Special Instructions/QC Requirements: <br /> Empty Kit Reh y: Date: Time: Method of Shipment: <br /> Relinquished by: DaieJfm Company Received by: Date/rime, Company <br /> 5 <br /> Relinqui a V e Co p y Received by: Date! ime: Company <br /> Relinquished by: Datamme: Company Recei d by: ` Date/Time: +-� Company <br /> — —w r����L7! oy�7 12-0 <br /> Custody Seals Intact: Custod7r Seal No-: Cooler Temparature(s)°C and Mar Remarks: <br /> A Yes A No <br />