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TestAmerica San Francisco <br /> 1220 Quarry Lane Chain of Custody Record �j TestAmerli <br /> ca <br /> Pleasanton, CA 94566 <br /> •ii i i tr5i f `47 4!a <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 720-10706.1 <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 720-32187-1 <br /> Address: Due Date Requested: ''"°Preservation Codes: <br /> 2795 Second Street,Suite 300, 12121/2010 <br /> �,., A-HCL M-Hexane <br /> City: TAT Requested(days): 8-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> D-Nitric Acid P-Na204S <br /> State,Zip: E-NaHSO4 Q-Na2SO3 <br /> CA,95616 �gg4 F-McOH R-Na2S2SO3 <br /> Phone: PO#: t G-Amchlor S-H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: ,`; I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> a K-EDTA W-ph 4-5 <br /> Project Name: Project#: U L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0fi <br /> Site: SSOW#: ) = a Other: <br /> H <br /> U <br /> Sample Matrix t <br /> Type (w-water Z <br /> YP <br /> NSample (C=comp os..aiit m <br /> Sam le Identification-Client ID Lab ID Sample Date Time G= rab er n aaa a ni ai S ecial InstructionILQ <br /> (D 0111",_ =€ <br /> 7501 KIERNAN 2008 EFF(720-32187-1) 12/7110 13:45 acific Water X 91 <br /> O 7501 KIERNAN 2008 MID(720-32187-2) 12/7110 13:50 Water XY C1 2 <br /> I-h Pacific <br /> s <br /> i r 7501 KIERNAN 2008 tNF(720-32187-3) 12/7110 13:54 Water X ate" 43 <br /> to <br /> Pacific <br /> 5725 HALL 2009 EFF(720-32187-4) 12/7110 14:09 Water X 94- <br /> acific <br /> e¢ <br /> 5725 HALL 2009 MID(720-32187-5) 12/7/10 14.15 Water X A <br /> Pacific <br /> 5725 HALL 2009 INF(720-32187-6) 12/7/10 Pacific <br /> Water X15: {o <br /> P ifi <br /> 802 VERA EFF(720-32187-7) 12/7/10 acWater X 7 <br /> Pacific if <br /> 5:21 <br /> 802 VERA MID(720-32187-8) 12/7/10 11ifi Water XPac ' <br /> 802 VERA INF(720-32187-9) 12/7/10 15'24 Water Xacific <br /> n <br /> TB-120710(720-32187-10) 12/7110 16:00Water <br /> Pacific <br /> X lb <br /> k <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> Non-Hazard O Flammable 0 Skin Irritant Poison B Unknown Radiological 0 Return To Client Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV, Other(specify) Special Instructions/QC Requirements: <br /> v <br /> CDD Empty Kit Relinquished by: Date: Time: P <br /> Methotl of Shipment: <br /> � Relinquished by: Daterrime: Company Received by: Daterrime: Company <br /> Relinquished by: Daterrime: Company Receivetl b : Daterrime: Company <br /> —4 <br /> Relinquished b Daterrime: Compan iv to 1 i o1 1 C pa <br /> Custody Seals Intact: Custody Seal No.: lCoole perature(s)°C and Ott Remark. U <br /> A Yes o No <br />