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TestAmerica San Francisco 7 !;—o rD <br /> 1220 Quarry Lane Chain of Custody Record Teir..1"tA l�y�,ierica <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 720-10334.1 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving idimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Analysis Requested 720-31290-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, 11/2/2010 A-HCL M-Hexane <br /> City: TAT Requested(days): r B-i N-None <br /> Davis C-Zn Acetate C-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> CA,95616 E-1 0-1 <br /> F-i R-Na2S2S03 <br /> Phone: PO#: <br /> -` G-Amchlor S-H2SO4 <br /> a H-Ascorbic Acid T-TSP Dodecahydrate <br /> a <br /> Email: WO#: ,Nss I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> Project Name: Project#: 5. K-EDTA W-ph 4-5 <br /> U L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site: SSOW#: _ Other: <br /> U <br /> Sample Matrix <br /> Type (W•wea., Z ,. <br /> Yp B-111 U <br /> ro Sample (C=comp o wastei <br /> Sam le Identification-Client ID Lab ID Sample Date Time ii BT Tissue A-Air U) Special Instructions/Note <br /> UZI <br /> (D ,,.c-fig .,,� se1', try ,� <br /> w 7501 KIERNAN 2008 EFF(720-31290-1) 10/19/10 P5: fi Water X —O <br /> O 7501 KIERNAN 2008 MID(720-31290-2) 10/19/10 15:28 Water X —� <br /> Hh <br /> Pacific <br /> 1458 a <br /> F� 5725 HALL 2009 EFF(720-31290-3) 10119/10 Water X <br /> Ln Pacific <br /> s <br /> 5725 HALL 2009 MID(720-31290-4) 10!19/10 Pa�? Water X <br /> 602 VERA EFF(720-31290-5) 10/19/10 15:05 Water X J f <br /> Pacific <br /> 802 VERA MID(720-31290-6) 10/19/10 15:07 Water X <br /> Pacific <br /> TB-101910(720-31290-7) 10119/10 16:05Pacific <br /> (Nater X U <br /> xe . <br /> g <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed ifsamples are retained longer than 1 month) <br /> =Non-Hazard =Flammable =Skin Irritant Poison 8 Unknown Radiological =Retum To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested: I,II,III, IV,Other(specify) Special Instructions/QC Requirements: <br /> v <br /> CD Method of ShipmCD ent:Empty Kit Relinquished by. Date: Time: <br /> Relinquished by: '- Daterrime: Comp�an; r Received by: Date/time: Company <br /> O <br /> Relinquished by Date[Time: eceive y: Daterrime: Com any <br /> W <br /> Relinquished by: Date/time: Coma Received b - errime Company <br /> 102-1 2L Z <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C nd Other Remark <br /> e Yes A No <br />