Laserfiche WebLink
TestAmerica San Francisco <br /> 1220 Quarry LaneGain of Custody Record t me <br /> Measantort, CA 94566O <br /> Phone(925)484-1919 Fax(925)600-3002 +r:s.r�.�r esn Baa}. gar.Fc:.: sz�csr¢ ct N <br /> Sampler: Lab PW Carrier Tracking No(s): COC No: t` <br /> O <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-10875.1 <br /> Client Contact Phone: E-mal Page: O <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page i of 1 <br /> Company: - Sob#: <br /> KIFF Analytical Analysis Requested 720-32521-1 <br /> Address: Due Date Requested: Preservation Codas: <br /> 2795 Second Street,Suite 300, 111212011 <br /> A-HCl. Ni-Hexane <br /> City: TAT Requested{days): B-NaOH tv-None <br /> Davis r C-Zn Acetate 0-ASN202 <br /> State,Zip: D-Nitric Acid P-Na204S <br /> E-NaHSO4 0-Na2S03 <br /> CA,95616 <br /> F-MeOH R-Na2S2S03 <br /> Phone: PO#: <br /> G-Amchlor S-H2SO4 <br /> :v H-Ascorbic Ac€d T-TSP Dodecahydrate <br /> .r <br /> Email. WO#. I-Ice 0-Acetone <br /> a J-01 water V,MCAA <br /> Project Name: Project#: 0 - K-EDTA W-ph 4-5 <br /> L-EDA Z-othar(specify) <br /> Nestle-Ripon 72000255 0 <br /> Site: SSOW#: Other. <br /> Sample Matrix <br /> Type e:. r., 0O i <br /> s <br /> Sample (C=Comp, a•w,.s.€o3, m <br /> Sample Identification-Client€D Lab ID Sample Date Time G=grab) 8T•Tlssve,A•Air vis Special Instructions/Note: cV <br /> Q <br /> TB-122810(720-32521-1) 12/28110 1145 Water X <br /> Pa i is <br /> 31 <br /> AB-122810(720-32521-2) 12/28110 Pacific PcifWater X <br /> V-p <br /> d <br /> ~ -: <br /> 4 <br /> Possible Hazard Identification Sample Disposal(A fee maybe assessed if samples are retained longer than 9 month) <br /> =Non-Hazard ©Flammable ©Skin Irritant � Poison B � Unknown © Radiological ©Return To Client ©Disposal sy Lab © Archive For Months <br /> Deliverable Requested:t,11,Ili,IV,Other(specify) Special lnstructiOns/QC Requirements: <br /> Empty Kit Relinquished by: Bate: Time: Method of Shipment: <br /> Relinquished 6y: Datel7me: Company Received by: Dateffime: Company <br /> Reiinquished by: Date/Time: Company Received by: DatefTime: Company <br /> Rel[nquishad by: Date/Time: Company Recetvad by: Date/Time: Company <br /> Custody Seals;;lntact Custody Seal No Caola[Temperaf!rets) C andOlher)3emarks <br />