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TestAmerica San Francisco 56 15 7 <br /> 1220 Quarry Lane Chain of Custody Record TestAmeric <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 720-10332 1 <br /> Client Contact Phone: E-Mail: Page: <br /> Shipping/Receiving I dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Analysis Requested 720-31291-1 <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): B-NaOH N-None <br /> Davis C-Zn Acetate O-AsNa02 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> CA,95616 E-NaHSO4 Q-Na2SO3 <br /> F-McOH R-Na2S2SO3 <br /> Phone: PO#: <br /> '¢ G-Amchlor S-H2SO4 <br /> a H-Ascorbic Acid T-TSP Dodecahydrate <br /> v <br /> Email: WO#: ,N { I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> Project Name: Project#: m` K-EDTA W-ph 4-5 <br /> 1 U L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site: SSOW#: _ Other: <br /> F <br /> U <br /> Sample Matrix <br /> (Wwahr, Z <br /> Type S-salta, U <br /> b Sample (C=comp, <br /> N Sam le Identification-Client ID Lab ID Sample Date Time G- rab) BT-Tissue,A-Airai I Special Instructions/Note <br /> LQ <br /> 10 <br /> � . <br /> f <br /> N RC-1 (720-31291-1) 10/19/10 14:15 WaterX t '� D� <br /> w Pacific _ n <br /> O 7717 KIERNAN(720-31291-3) 10/19/10 15:40 Water X 4Z <br /> t•h Pacific <br /> LA) 7969 KIERNAN(720-31291-5) 10!19/10 16:00 Water XPacific - <br /> ~ 5:40 <br /> 7971 KIERNAN(720-31291-6) 10/19/10 11ifi Water XPac - <br /> 110 MANLEY(720-31291-7) 10/19/10 15:24 Water X <br /> Pacific <br /> s-� <br /> 15:18 <br /> 361 PARELLEL(720-31291-8) 10/19/10 Pacific Water X —J 6 <br /> 1051 ROBERT(720-31291-9) 10/19/10 14:50P Water X <br /> T <br /> 'a <br /> F. <br /> Possible Hazard Identirication Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> =Non-Hazard =Flammable Skin Irritant Poison B Unknown Radiological =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 /> Empty li ed bDate: Time:y: <br /> (DMethod of Shipment: <br /> Kit Re <br /> Relinquishe i D@tVime: Company Received by: Daterrime: Company <br /> o <br /> Relinquished by: Daterrime Company Received by: Daterrime: <br /> Relinquished by. Date/Time: Company Re 'vecl ime: Company <br /> /b2- <br /> Custody Seals Intact: Custody Seal No.: Cool mperature(s)°C 6nd Other Remarks: <br /> 0 Yes o No <br />