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TestAmerica San Francisco ���� � �� <br /> 1220 Quarry Lane Chain of CustodyRecord <br /> Pleasanton, CA 94566 D� <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> N SFONfpt Ai T,At T--`.I N(,- <br /> Sampler: <br /> CeSampler: Lab PM. CarrierTracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-9614.1 <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 720-29641-1 <br /> Address: Due Date Requested: S Preservation Codes: <br /> 2795 Second Street,Suite 300, 8/12/2010 A-HCl M-Hexane <br /> City TAT Requested(days): <br /> F. B-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> State,Zip: `R D-Nitric Acid P-Na204S <br /> CA,95616 E-NaHSO4 Q-Na2S03 <br /> Phone: PO# <br /> e+ F-MeOH R-Na2S2S03 <br /> a � G-Amchlor S-H2SO4 <br /> v H-Ascorbic Acid T-TSPDodecahydrate <br /> Emal1'. <br /> WO#: ie I-Ice U-Acetone <br /> T <br /> J-DI Water V-MCAA <br /> Project Name: Project#, a S� K-EDTA W-ph 4-5 <br /> Nestle-Ripon 72000256 p L-EDA Z-other(specify) <br /> Site: SSOW#: _ Other: <br /> U <br /> 4 <br /> Sample Matrix <br /> Type (w-wu0 <br /> s-.one U <br /> Sample (C comp o „e,„ <br /> Sam le Identification-Client ID Lab ID Sam le Date Time G rob aT n e,A Ao- rn <br /> rd Special Instructions/Note: <br /> LQ <br /> (D RC-1 (720-29641-1)W,. 7/29/10 P0'Pacific <br /> X Aug <br /> (� <br /> 00 <br /> O <br /> Hh <br /> F- <br /> 0 <br /> qe$' <br /> Rq <br /> 0!,, <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> O Non-Hazard =Flammable Skin trntant 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 /> Empty Kit Relinquished by: Date: Time: Method of Shipment <br /> W Relinquishe Date me C me ny Received by: Daterfime. Company <br /> CD <br /> 2110 �� <br /> v Relinquished by: Date/Time Com any Received by: Date/Time. Company <br /> O <br /> 00 Relinquished by: Date/Time: Company Re d b D� Cc pany <br /> 14 <br /> Custody Seals Intact: Custody Seal No.: Cooler re erature(s)°C and Other Remarks, <br /> 0 Yes A No 1 1 44 <br />