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TestAmerica San Francisco [ Test mC✓n'ca <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> Phone(925)464-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma, Dimple 720-10173.1 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Job#. <br /> Company: <br /> KIFF Analytical Analysis Requested 720-30962-2 <br /> Preservation Codes: <br /> Address: Due Date Requested; :aQ <br /> 2795 Second Street,Suite 300, 1016/2010 A-HCL M-Hexane <br /> TAT Requested(days): & s. B-NaOH N-None <br /> City: ase C-Zn Acetate 0-ASNa02 <br /> Davis <br /> D-Nitric Acid P-Na204S <br /> State,Zip: 't E-NaHSO4 Q-Na2SO3 <br /> CA,95616 F-MeOH R-Na2S2SC3 <br /> Phone: PO#: °.^ G-Amchlor S-H2SO4 <br /> �! H-Ascorbic Acid T-TSP Dodecahydrate <br /> I-Ice U-Acetone <br /> Email: WO#: T ' J-DI Water V-MCAA <br /> :g K-EDTA W-ph 4-5 <br /> Project Name: Project#. t i r L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 > r s Other: <br /> Site: SSOW#', <br /> t <br /> Manx <br /> Sample <br /> Typez0 <br /> b Sample (C=Comp, o w,.n n m <br /> 01 Special <br /> LQ Sample Identification Client ID Lab ID Sample Date Time G=grab) ar n ..a no- w <br /> a. 3 '°r, a.e° <br /> 0 5725 HALL 2009 EFF(720-30962-4) 10/5110 09.28 Water X <br /> Pacifi <br /> O 5725 HALL 2009 MID(720-30962-5) 10/5110 09'32 Water X 4 Z <br /> Pacific "r <br /> N 5725 HALL 2009 INF(720-30962-6) 10/5/10 09:36 Water X � <br /> W P if <br /> asst <br /> 1 <br /> =t3°: <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 O Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:1,ll, III,IV,Other(specify) Special Instructions/QC Requirements: <br /> Date: Time: <br /> Method of Shipment. <br /> (D Empty Kit Relinquished by: <br /> (0) Relinquished by. Date/Time: _ ( CompanyReceived by: Date/Time: Company <br /> Relinquished by. <br /> DatelTime: Company Received by: Daterrime Company <br /> CD <br /> Relinquished b: Daterrime: Received� Date/Tim Comp <br /> q Y roDS�[� h� l <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and other Remarks. <br /> A Yes o No <br />