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TestAmerica San FranciscoTestAmed a <br /> 1220 Quarry Lane Chain of Custody Record <br /> �� <br /> Pleasanton, CA 94566 -7rf-OFF <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) E-MailShar ,Dimple Page 512.1 <br /> Phone: E-Mail: Page. <br /> Client Contact Page 1 of 1 <br /> Shipping/Receiving dimple.sharma@testamericainc,com 9 <br /> Job#, <br /> Company: Analysis Requested 720-31709-1 <br /> KIFF Analytical tb'`Preservation Codes: <br /> Address. Due Date Requested: <br /> 2795 Second Street,Suite 300, 11/23/2010 A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> C-Zn Acetate O-AsNa02 <br /> Davis :`' D-Nitric Acid P-Na204S <br /> State,Zip: Vii! E-NaHSO4 Q-Na2SO3 <br /> CA,95616 F-McDH R-Na2S2SO3 <br /> Phone. PO#: a a G-Amchlor S-H2SO4 <br /> meq. H-Ascorbic Acid T-TSP Dodecahydrate <br /> n I-Ice U-Acetone <br /> Email: w0#. '� xs J-DI Water V-MCAA <br /> a <br /> X! <�. �� K-EDTA W-ph 4-5 <br /> - L-EDA Z-other(specify) <br /> Project Name: Project#: O y <br /> Nestle-Ripon 72000256 = Other: <br /> Site: SSow#. <br /> U <br /> Ua <br /> Sample Matrix 9 <br /> (w-water, Z ? <br /> rd <br /> Type s.:una U <br /> N Sample (C=comp, 0-3W011, <br /> j <br /> Sens/Note: <br /> Client ID Sample Date Time G=grab) BT TI e,a-Ar <br /> Sam le Identification- <br /> 22 <br /> W RC-1 (720-31709-4) 1119110 <br /> Pacific Water X <br /> � <br /> D-h 7717 KIERNAN(720-31709-6) 11/9/10 Pacific <br /> lP ifi Water X 2 <br /> 10:29 <br /> 00 Water X <br /> 1051 ROBERT(720-31709-7) 11/9/10 Pacific <br /> a:ua: <br /> A., <br /> ' <br /> aw <br /> sa`.. <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 0 Non-Hazard 0 Flammable Skin Irritant Poison B Unknown Radiological =Return To Client 0 Disposal By Lab Archive For Months <br /> v <br /> Deliverable Requested: I,II, III, IV,Other(specify) Special Instructions/QC Requirements: <br /> rQ <br /> Empty Kit Relinquished by: Date: Time: Method of Shipment <br /> CD Relinquished Datel-rime: Company Received by: Daterrime. Company <br /> i <br /> OLr� t t b DO,_ <br /> Relinquished by: Date ime: Co Received by: DatelTime: Company <br /> Relinquished by: Received by: , Date/time: Company <br /> Custody Seals Intact: Custody Seal No.: Coolerre refs) and other Remarks <br /> A Yes A No <br />