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TestAmerlca San Franciscoam§ O <br /> TestAmet <br /> 1220 QuazTy lane ��` t r /�'1� L��T N <br /> ...�:..A::3c?tt�chY€°�•ClNR±EN:t1 l cS e{€;C; <br /> Chainof Custody Record <br /> Pleas—niton,CA 94566 <br /> phone 925.484.1919 fax 925.600.3002 TestAmerica Laboratories,Inc. <br /> Client Contact Project Manager: Rinayak-cizarya Site Contact:Martz Czipka rDate: ICOC No: <br /> Environmental Cost Munaaement lnc.(ECM) Tie1 Fax: (661)255-1693 I ab Contact:Dimple Sharma Sampler: of CC3Cs <br /> 3325 Hyland Ave Suite 200 Analysis Euraa.-ped':inxe :� <br /> Job No. <br /> Costa Mesa,CA 92626 Calendar(C)or Work Days(W} C ; <br /> (714)862-2759 Phone TAT&dfier if mBdcw <br /> A <br /> (714)662-2758 FAX 2 w,--ks I <br /> SDG No. <br /> Project Name: Nestle © ;weekSite: Ripon, 2days ' € <br /> P0# O lday <br /> � w € <br /> Sample #� <br /> Sample Identification ]Date Time Pres Matrix Coat Sample Specific Notes: <br /> TB-05061' X14 TIC1 H2O 2 x <br /> EU3&EU4MID j- j ,5 HCI H2O 3 X co <br /> 0 <br /> (D <br /> Cu <br /> D_ <br /> Preservation Used: 1-Ice, 2=HCl; 3=HZSO4; 4-HNO3; 5--NaOH;6=Other <br /> Possible Hazard Ids'Zcadan Sample Disposal(A fee may be assessed ifsamples are retained longer than 1 month) <br /> ® Non Rarard I]Flammable © Slan Imrant Poison S� Unknown ©Retum To Client ®Disposal By Lab Archive For Months <br /> Special InstruetlouslQC Requirements Comments: REPORT DATA IN EDF FORMAT GLOBAL fD SL205012989 <br /> Relinquished by d .' Company:Environmental DatefTime: /L Received Company:Test America DatelTime <br /> i �' Cost Management,Inc. �57Q) i <br /> Relinquished by_ Company. DateJTime: Received by: Company_ Date/Time: <br /> R6mq—hedby: Campany DaIdTime. Received by: Company. DateFfine: <br />