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TestAmerica San Francisco- 1 est m n <br /> ca <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 720-10852.1 <br /> Client Contact. Phone. E-Mail: Page, <br /> ShippinglReceiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Job#: <br /> Analysis Requested 720-32468-1 <br /> Address: Due Date Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, V7/2011 K9A-HCL M-Hexane <br /> City: <br /> TAT Requested(days): '° 8-NaOH N-None <br /> Davis , C-Zn Acetate 0-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> x E-NaHSO4 Q-Na2SO3 <br /> CA,95616 '` F-McOH R-Na2S2SO3 <br /> Phone: PO#: f <br /> N G-Amchlor S-H2SO4 <br /> N " H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: I-Ice U-Acetone <br /> c ? J-DI Water V-MCAA <br /> Pro ect Name: Project#: w g K-EDTA W-ph 4-5 <br /> I UO L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 <br /> Site: SSOW#: _ Other: <br /> UU <br /> Sample Matrix <br /> T (w.w.,., 0 <br /> Type <br /> NSample (C=comp <br /> W Sample Identification-Client ID Lab ID Sam le Date Time G= rab sr Tie :,A-An S ectal InstructlonslNote <br /> -y <br /> offi <br /> w 7501 KIERNAN 2008 EFF(720-32468-1) 12/21/10 P cif Water X <br /> p 14:32Water X 6 D 2 <br /> 7501 KIERNAN 2008 MID(720-32488-2) 12!21/10 Pacific <br /> 5725 HALL 2009 EFF(720-32468-3) 12/21110 14:46P if Water XL11 <br /> 5725 HALL 2009 MID(720-32468-4) 12/21110 14:49 Water X (AP ifi _ <br /> 802 VERA EFF(720-32468-5) 12121/10 ac15: Water X dS <br /> Pacific Pifi <br /> 15:14 <br /> 802 VERA MID(720-32468-6) 12/21/10 Pacific Water X Q <br /> TB-122110(720-32468-7) 12/21/10 P6 f Water X g, D-7 <br /> S, <br /> o <br /> lg!t <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =Non-Hazard E=Flammable Skin Irritant Poison B Unknown Radiological =Retum To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I, II, III,I ,Other(specify) Special Instructions/QC Requirements. <br /> Lav <br /> CD Empty Kit Relinquish e Date: Time: Method of shipment <br /> N Relinquished by Da !ri � F `i � Com Received by Date/Time: Company <br /> O IS Z f IV <br /> � <br /> Relinquished by Date/rine: Company Received by. om an <br /> W '-- <br /> Relinquished by. Date/Time: Company Received by. Date/Time: Company <br /> 11 <br /> Custody Seals Intact: Custody Seal No.: CoolerTemperature(s)°C and Other Remarks: <br /> A Yes o No <br />