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❑ ❑ ❑ ❑ L e <br /> 00 <br /> TestAmerica San Franciscoj( �y�E/�' ' N <br /> 1220 Quarr}Lane TestA ' 'edea N <br /> Chain of Custody Record li•t tt AD,'-,4 IN�NvirusasnWAl.fcSif(PI i 00 <br /> Pleasanton,CA 945o6 j 9-417 5S <br /> phone 925 484 1910 fax 925 600 3002 TestAmerica Laboratories,Inc. <br /> Client Contact Proicct Nlanager: Rinayak Aeharya Site Contact:Mark Czipka Date: $- y$ CDC No <br /> ECM Consultants Tel/Fax: (66t)2554693 Lab Contact:Dimple Sharma sampler:C WA (1%Y 'wr xt of COCl <br /> 3525 Hyland Ave Suite 200 Analysis Turnaround Time Job No <br /> Costa Mesa,CA 92626 Calendar(C)or Work flays(W) C t' <br /> sSj= <br /> (714)662-2759 Phone TAT if differ=[fmm Below _ <br /> (714)662-2756 FAX ® ?weeks $ S1)G No <br /> Project Name: Nestle ]week <br /> Site Ripon,CA E=) 2 days m e <br /> P 0# © 1 day ° v <br /> a ate. <br /> m � <br /> Sample #or O O <br /> Sam le Identifcattaa Sample Date Time Pres. Matrix Cont 5 's Sample Specific Notes <br /> RPS-1 -7-I °! nC1 1120 3 X <br /> 0 <br /> 0 <br /> co <br /> a_ <br /> Preservation Used: 1=Ice, 2=HCl; 3=H2SO4; 4=HN03; 5=NaOH;6—Other <br /> Possible Hazard Identifrcatlan Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> ® Nun-Hu-ard 0 I-lumm ehle © skin Irruani Poison H© I/nknti n © Return 7o Client ®Disposal By Lab =1Arc1rve Far Months <br /> Special lustructionslQC'Requirements&Comments: NOGEOTKACKER <br /> Relinquished by Company Datelh e/ Receivey Companv Test America Date/Tmie <br /> 1-1-CM Consultants <br /> Reltnquishedby Company DattfTtme Receive y Company— <br /> Relinquished <br /> ompanyRelinquished by Company Daterllme Received by Company Datell"tme <br />