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TestAmerica San Francisco 763�2, <br /> T�stmerica <br /> Quarry Lane Chain of Custod Record -Plea Plea <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 720-10512.1 <br /> Client Contact: Phone: E-Mail: Page. <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job 9, <br /> KIFF Analytical Analysis Requested 720-31708-1 <br /> Address: Due Date Requested: W <br /> y-` Preservation Codes: <br /> 2795 Second Street,Suite 300, 11/2312010 <br /> ,g A-HCL M-Hexane <br /> City: TAT Requested(days): n�°E B-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> State,Zip: n D-Nitric Acid P-Na204S <br /> CA,95616 N.. F-NaHSO4 O3 <br /> MeOHR-Na2S <br /> Phone: PO#: a^ <br /> a e G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email. WO#: ,N , I-Ice U-Acetone <br /> ` - J-Dl Water V-MCRA <br /> Project Name: Project#: a K-EDTA W-ph 4-5 <br /> Nestle-Ripon 72000256 0 L-EDA Z-other(specify) <br /> Site: SSCW#: = Other: <br /> U m4 <br /> Sample Matrix <br /> Type (w.w.e O <br /> ro Sample (C=comp o 8 <br /> Iv Sample Identification-Client ID Lab ID) Sample Date Time G=grab) ar n ue,A•Air rn Special Instructions/Note: <br /> Ell <br /> 7501 KIERNAN 2008 EFF(720-31708-1) 11/9/10 P3 :03 Water X 0 <br /> 00 <br /> ic <br /> 7501 KIERNAN 2008 MID(720-31708-2) 11/9/10 P3'�i Water X ? Q <br /> _ <br /> N 7501 KIERNAN 2008 INF 13:11 <br /> (720-31708-3) 1119/10 P if Water X O <br /> F- <br /> 5725 HALL 2009 EFF(720-31708-4) 11/9/10 13:Pacific Water X ", Q <br /> 5725 HALL 2009 MID(720-31708-5) 11/9/10 13:31 Water X <br /> Pacific ,a z <br /> 5725 HALL 2009 INF(720-31708-6) 11/9/10 13.35 fc Water X ° <br /> 802 VERA EFF(720-31708-7) 11/9/10 10:07 Water X ° <br /> Pacific <br /> 802 VERA MID(720-31708-8) 11/9/10 Pacific Water X <br /> 802 VERA INF(720-31708-9) 11/9/10 Po.ti Water X Cf <br /> TB-110910(720-31708-10) 11/9/10 16;25 Water X <br /> Pacific �w <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 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 /> w <br /> CD <br /> (D Empty Kit Relinquished by: Date: Time: Method of shipment: <br /> Relinquished by: Date/rime: Com any Received by: Date/Time: Company <br /> v <br /> O Q if <br /> �+ Relinquished by: Dat ime: Company Received by: Date/rime: Company <br /> Relinquished by: Date/Time: Compan Receivetl by: Date/rime: Company <br /> Custody Seals Intact: Custody Seal No.: Cooler T a r s) nd Other Rema <br /> o Yes 0 No <br />