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TestAmerica San Francisco 7 5 " 3 <br /> 1220 Quarry Lane Chain of Custody Record TestA erlc() <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 720-9383.1 <br /> Client Contact. Phone. E-Mail: Page <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company. Job#. <br /> KIFF Analytical Analysis Requested 720-29164-1 <br /> Address: Due Date Requested: +Preservation Codes: <br /> 2795 Second Street,Suite 300, 7/20/2010 ': <br /> -Hexane <br /> City TAT Requested(days): R A-HCL M <br /> se' B-NaOH N-None <br /> Davis '.. C-Zn Acetate 0-AsNa02 <br /> State,Zip. D-Nitric Acid P-Na204S <br /> CA,95616 E-NaHSO4 Q-Na2SO3 <br /> ek F-McOH R-Na2S2SO3 <br /> Phone, PO# - <br /> Cl! G-Amchlor S-H2SO4 <br /> r <br /> � H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: ,N I-Ice U-Acetone <br /> a E'.. ..1 J-Dl Water V-MCAA <br /> Project Name: Project#: K-EDTA W-ph 4-5 <br /> Nestle-Ripon 72000256 p `fie L-EDA Z-other(specify) <br /> > i <br /> Site: SSOW#: _ Other: <br /> U � <br /> Sample Matrix g ' <br /> Type (w-wero 0 <br /> T 8 <br /> YP S-1011d, U <br /> to Sample (C=comp, o-wager n m <br /> Sample Identification-Client ID Lab ID Sam Is Date Time G= rab) ST-Tissue,A-An ` of I ?Fspecial Instructions/Note: <br /> <° .,",- .a.- :'. "'a •°ass°-'r5 v'° ��¢° ••tE 1: ggq,,,,;` <br /> +ab ,. -Is s��"Ilk <br /> 01 I `a a sa r <br /> .0?,R'tx 'a .,:; b •.•F& .s, BeY R kk n ✓ t. <br /> � 110 MANLEY(720-29164-2) 7/6/10 P6'1fs Water X <br /> � 361 PARALLEL(720-29164-3) 7/6/10 P6'Ifs Water X r tt��1 <br /> N 7717 KIERNAN(720-29164-4) 7/6/10 15.40 Water X eQ v3 <br /> v <br /> Pacific = <br /> 7969 KIERNAN(720-29164-5) 7/6/10 PS.Ifi Water X oq <br /> 7971 KIERNAN(720-29164-6) 7/6/10 P5'If Water Xe S <br /> Hsf <br /> Agpg <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 B 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 /> v <br /> CID <br /> CCD Empty Kit Re Ise by: Date: Time: Method of shipment. <br /> Relinquished b !� Datis�Qj7ne.��,� Company Received by Dale/Time: Company <br /> Relinquished by f Daterrtme: Company Received by atefrime: Company <br /> 17 A <br /> F-` Relinquished by Daterrime: Company ARe D te/TOe.-'O I�� p7 -7 Custody Seals Intact: Custody Seal No.: emperature(s)°C and Other Remarks <br /> A Yes A No <br />