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TestAmerica San Francisco <br /> 1220 Quarry LaneTestAmedca <br /> Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> 3ctC?,ii3"5E€E 1t•) <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking No(s): CCC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-9688.1 <br /> client Contact: Phone: E-Mai€: Page: <br /> ShippingiReceiving dimple.shorma@testamericainc.com Page I of 1 <br /> Company: Job#: <br /> KIFF Analytical Analysis Requested 720-29858-1 <br /> Address: Due Bate Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, 8/11/2010 A-HCL M-Hexane <br /> City: TAT Requested(days): 8-NaOH N-None <br /> Davis 0 Z Acetate 0-ASNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> CA,95616 E-NaHSO4 Q-Na2S03 <br /> P-McOH R-Na2S2SC3 <br /> Phone: PO#: <br /> G-Amehlor S•H2504 <br /> tt-Ascorb[c Add T•TSP Dodecahydrate <br /> Email: WO#: ,=, I-lee 0-Acetone <br /> .87 J-DI Water V-MCAA <br /> Project Name: Project*: W K-FDTA W-ph 4-5 <br /> U - e L-EDA 2-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site: SSOW4: _ Other: <br /> f- <br /> U <br /> Sample Matrix Z �" <br /> Type (w«wa er, d 2 <br /> Sasufl6, (j <br /> Sample (C=comp, o=wa:reo€i, m <br /> Sample Identification-Client ID Lab ID) Sample Date Time G= rab) eT=Tissue,A=A" S ecial Instructions{Note: <br /> n <br /> 44 <br /> 1051 ROBERT(720-29858-1) 8110110 08-04 Water X o <br /> Pacific <br /> 802 VERA(720.29858-2) 8110!10 11136 Water X <br /> Pggifip <br /> TB-0&1010(720-29858-3) 8110110 10:00Pacific Water X <br /> �t <br /> _A_ <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 Radfofo icaf ©Return To Client =Lsposaf By Lab 1D Archive For Months <br /> [Deliverable Requested:i,Ii,Ill,IV,Other(specify) Special Instructions=Requirements: <br /> Empty Kit Refjnqu€shed by: Date: Time: Method of Shipment <br /> Relinquished by, Dateflinw Company Received by: Daterrime: Company <br /> Relinquished by: Date/Time: Company Received by: Daterl ime: Company <br /> Relinquished by: Datafrime: Company Received by: Datefrime' Company <br /> Custody Seals lntaci Custotly Seal Na } C90fkr einperature(s)C and Other Remarks <br />