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TestAmerica San Francisco -�3�� <br /> 1220 Quarry Lane Chain of Custody Record TSrrrc <br /> Pleasanton, CA 94566 <br /> WIN <br /> Phone(925)484-1919 Fax(925)600-3002 E: .r ni r yvr .A, r.Ta•«'r. <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-9569.1 <br /> Client Contact Phone. E-MailShipping/Receiving idimple.sharma@testamericainc.com Page: <br /> Company Page 1 of 1 <br /> KIFF Analytical Job#. <br /> AddressAnal sis Requested 720-29513-1 <br /> : Due Date Requested: . <br /> 2795 Second Street,Suite 300, 8/6/2010 Preservation Codes:� <br /> ' <br /> City: TAT Requested(days): ° A-HCL M-Hexane <br /> Davis SwT.. B-NaOH N-None <br /> '° C-Zn Acetate 0-AsNa02 <br /> State,Zip. <br /> -Nitric Acid P- <br /> CA,95616 E-NaHSO4 0-Na2803 <br /> Phone, PO#: F-McOH R-Na2S2SO3 <br /> ft <br /> Cl! G-Amchlor S-H2SO4 <br /> Email: <br /> WO#: N H-Ascorbic Acid T-TSP Dodecahydrate <br /> W) I-Ice U-Acetone <br /> a J-DI Water V-MCAA <br /> Project Name: K-EDTA W-ph 4-5 <br /> Nestle-Ripon 72000256p L-EDA Z-other(specify) <br /> � > <br /> Site. SSOW#: _ Other: <br /> F <br /> Sample Metrix <br /> Type (W—ter, 0 <br /> Sam s ud <br /> Sample (Ccomp o t r n, MU <br /> rd Sam le Identification Client ID Lab ID Sample Date Time G rab) ar n apo- V=1 <br /> �^ y „v,t, ... .#; eeial Instructions/Note <br /> UZI <br /> .._ - :.N. �. � � �1 <br /> 720-29513-1 10:00 <br /> 1051 ROBERT <br /> ( ) 7/23/10 Pacific Water X a U <br /> O802 VERA(720-29513-2) 7/23/10 P 5:15 Water X <br /> TB-072310(720-29513-3) 7/23/10 10:15 Water X bZ <br /> —Pacific <br /> 03 <br /> N <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 0 Non-Hazard 0 Flammable Skin Irritant Poison B Unknown Radiological 0 Return To Client 0 Disposal By Lab Archive For Months <br /> Deliverable Requested. I, II, III, IV,Other(specify) Special Instructions/QC Requirements: <br /> v Empty Kit Relinquished by: Date: Time: Method of Shipment. <br /> CQ Relinqui y: Date ime: <br /> CD �O S��j� C m n Received by: DatelTime: <br /> --1 Company <br /> Relin is ed DatelTime. <br /> _.. Date/Time. Company <br /> CD Relinquished by: Received by: Daterrime: Com aqy <br /> Custody Seals Intact: Custody Seal No.: <br /> A Cooler Temperature(s)PIC and Other Rear <br /> mks <br /> Yes � No 1 <br />