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TestAmerica San Francisco _757 �;3 I .J f <br /> 1220 Quarry Lane Chain of Custody Record TestAme cla <br /> Pleasanton, CA 94566 tnexss N r as+,;r r r.I A. r.r.ca <br /> Phone(925)484-1919 Fax(925)600-3002Sill <br /> Sampler: Lab PM: Carrier Tracking Nc(s). COC No: <br /> Client Information (Sub Contract Lab) Sharma, Dimple 720-10726.1 <br /> Client Contact. Phone: E-Mail: Page. <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#. <br /> KIFF Analytical Analysis Requested 720-32218-1 <br /> Address. Due Date Requested: Preservation Codes: <br /> 2795 Second Street,Suite 300, 12/22/2010 <br /> A-HCL M-Hexane <br /> City: TAT Requested(days): B-NaOH N-None <br /> Davis C-Zn Acetate O-AsNa02 <br /> State,Zip. a: - D-Nitric Acid P-Na204S <br /> f9° E-NaHSO4 0-Na2SO3 <br /> CA,95616 4 F-McOH R-Na2S2SO3 <br /> Phone. PO � G-Amchlor S-H2SO4 <br /> N <br /> � H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: I-Ice U-Acetone <br /> J-DI Water V-MCAA <br /> Project Name. Project#: 'p K-EDTA W-ph 4-5 <br /> Pro <br /> 1 1 L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 <br /> Site: SSOW# i Other: <br /> F <br /> U <br /> Sample Matrix <br /> Type (w-weee, p <br /> s <br /> I'd Sample (C comp, oteam <br /> un <br /> N ication-Client ID ID Sam le Date Time G Special <br /> t Instructions/Note <br /> y< <br /> OD 5724 HALL(720-32218-1) 1219/10 1120 Water X " <br /> Pacific <br /> O . <br /> Hh <br /> W' <br /> tz <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> 0 Non-Hazard O Flammable Skin Irritant Poison B Unknown Radiological =Return To Client 0 Disposal By Lab Archive For Months <br /> Deliverable Requested: I,II, III IV, Other(specify) Special Instructions/QC Requirements: <br /> W Empty Kit Relinq y Date: Time: Method of Shipment: <br /> cn <br /> (D Relinquished by: _ D t i e: (� Comp Received by: Date/Time: Company <br /> —4 �^ J <br /> O Relinquished by: Date/T e: Company Received by: Datelrime: Company <br /> 00 <br /> Relin Company Received b- DatefTime. Co p ny <br /> Custody Seals Intact: Custody Seal No.: Cool mp rat r )°O and Other Remarks. <br /> A Yes A No <br />