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TestAmerica San Francisco 7�602 <br /> Te ti m ri <br /> 1220 Quarry Lane Chain of Custody Record <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 720-10596.1 <br /> Client Contact: Phone: E-Mail: Page <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Anal sis Requested 720-31929-1 <br /> Address: Due Date Requested: UNKK,,.Preservation Codes: <br /> 2795 Second Street,Suite 300, 12/8/2010 " <br /> a+,z. A-HCL M-Hexane <br /> City: TAT Requested(days): B-N80H N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> State,Zi D-Nitric Acid P-Na204S <br /> CA,95616 t E-NaHSO4 Q-Na2SO3 <br /> F-McOH R-Na2S2SO3 <br /> Phone: PO#: G-Amchlor S-H2SO4 <br /> N ` <br /> H-Ascorbic Acid T-TSP Dotlecahydrate <br /> Email. WO#: h I-Ice U-Acetone <br /> J-Dl Water V-MCAA <br /> Project Name, Project#: <br /> K-EDTA W-ph 4-5 <br /> 1 O L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 <br /> Site: SSOW#: = fr J Other: <br /> Q <br /> Sample Matrix ? <br /> P (w.wakr Z <br /> Type <br /> N Sample (CTC mp , osw,.armt, m <br /> W Sam le Identification-Client IDLab ID Sam le Date Time G=grab) eT T .A-Ao- w � Special Instructions/Note <br /> I'DF,y`.'�-"° p _ '. `� c.r s�' � ;€ � � �f r. ��a� '�` �'s rg�'�,.o ��� '�.� '. � � <br /> w 7501 KIERNAN 2008 EFF(720-31929-1) 11/23/10 09:31 Pacific Water X <br /> p09:35 ' 2 <br /> 1_1117501 KIERNAN 2008 MID(720-31929-2) 11/23/10 Pacific Water X <br /> 5725 HALL 2009 EFF(720-31929-3) 11/23/10 09:49 Water X <br /> Ln 5725 HALL 2009 MID(720-31929-4) 11/23/10 P ifi 09:52 Water X 0`1 <br /> 802 VERA EFF(720-31929-5) 11/23/10 09:07 Water X I tJ <br /> Pacific A <br /> 09:10 Q 6 <br /> 802 VERA MID(720-31929-6) 11/23/10 P ifi Water X ;•;a —7 <br /> TB-112310(720-31929-7) 11/23/10 P1:Ifl Water X o / <br /> F'F al <br /> Fig-- <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =Non-Hazard 0 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 Empty Kit Relinquished by: Date: Time: Method of Shipment: <br /> N Relinquished by: Dateriime. Company Received by: a me: Company <br /> o t (-Z <br /> Relinquished b P y <br /> � q y, Dale/1-ime: Com an Receiv d b� DatelTime: Company <br /> W <br /> Relinquished byl Dat ime. Compa R v by: D te/Time� Company <br /> Z I f0 1138 k; a TCC <br /> Custody Seals Intact: Custody Seal Cooler Temperature(s)°C and Other Remarks: <br /> A Yes 0 No <br />