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TestAmerica San Francisco r <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 720-10473.1 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company. w Job#: <br /> tories,Inc Anal sis Requested 720-31395-2 <br /> Address. Due Date Requested: 4 a Preservation Codes: <br /> 1118/2010 . A-HCL M-Hexane <br /> City TAT Requested(days): B-NaOH N-None <br /> C-Zn Acetate O-AsNa02 <br /> State,Zip D-Nitric Acid P-Na204S <br /> : r <br /> �, E-Nal O-Na2S03 <br /> F-McOH R-Na2S2SO3 <br /> Phone: PO#: G-Amchlor S-H2SO4 <br /> -s H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: � I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> ect#: K-EDTA W-ph 4-5 <br /> Pro <br /> Project Name. 1 U '-, L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 O <br /> Site. SSOW#: = y Other: <br /> U <br /> Sample Matrix <br /> Type (w-w.w <br /> to Sample (C=Comp os uta u 1j <br /> N Sam le Identification-Client ID Lab ID Sam le Date Time G= rab aT Ti .,A-Airto r S ectal Instructions/Note. <br /> UZI <br /> ,m � �:,, ,,• � <br /> W MW-3(720-31395-33) 10/22/10 P ifi 09:40 Water X el�SE W1� <br /> O MW-7(720-31395-34) 10/22/10 0909 Water <br /> rh Pacific <br /> H MW-9(720-31395-35) 10/22/10 09:19 Water XDo e <br /> Pacific MW-10(720-31395-36) 10/22/10 09.47 Water X lot <br /> Pacific <br /> MW-16(720-31395-37) 10/22/10 08:46P if Water X <br /> MW-18(720-31395-38) 10/22/10 08:52 Water Xj 0� <br /> Pacific <br /> 011 <br /> �N: <br /> Possible Hazard Identification Sample Disposal(A fee maybe assessed if samples are retained longer than 1 month) <br /> =Non-Hazard =Flammable Skin Irritant Poison B Unknown Radiological O Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:1,II, III,IV, Other(specify) Special Instructions/QC Requirements: <br /> v <br /> m <br /> Empty Kit Relinquished by: Date: Time: Method of Shipment <br /> NRelinquished b Date/Time: Company Received by. Datelrime: Company <br /> Relinquis '. DaterTime: Company Received by: Date/Time: Company <br /> y <br /> W <br /> Relinquished by Date/Time: Company Received Daterrime'. Co <br /> to 15w <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperatures)°C and Other Remarks. <br /> A Yes A No <br />