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0 <br /> TestAmerica San Francisco <br /> 1220 Quarry Lane Chain of Custody Record TestAm d <br /> ca <br /> Pleasanton, CA 94566 CD <br /> Phone(925)484-1919 Fax(925)600-3002 TfIC I2� e.a i bras z r€alk TAA`=UMW, C\J <br /> Sampler. Lab PM: Carher Tracking No(s): CDC No: p <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-10875.1 <br /> Client Contact: Phone: E-Mail: Pace: CD <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job#: <br /> KIFF Analytical Analysis Requested 720-32521-2 <br /> Address: Aue Date Requested: Preservatlon Codes: <br /> 2795 Second Street,Suite 300, 12I30f2010 <br /> A»HCL M»Hexane <br /> City: TAT Requested(days): S-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNaO2 <br /> State,Zip: D-Nitric Add P-Na204S <br /> CA,95616 <br /> E-NaHSt34 C-Na2503 <br /> F-McOH R-WS2So3 <br /> Phone: PO 4: <. <br /> G-Amchlor S•H2SO4 <br /> H-Ascorbic Acid T-TSP Dodecahydra€e <br /> Email: WO#: :`s:`c I-Ice U-Acetone <br /> J-t]I Water V-MCAA <br /> K-EDTA 'A'-ph4-S <br /> Project Name: ProjectfF: <br /> Nestle-Ripon 72000256 s:�,li U L-EOA Z-other(specify) <br /> Site: SSOWtF: .."'``.l- z -". Other: <br /> m� <br /> Sample Matrix W <br /> Type <br /> i• a (Wawaler, O <br /> Yp <br /> Sample (C=comp, rweatuan. m �w <br /> Sample Identification-Client ID Lab ID Sam Te Date Time G=grab) eT•Ti.s ,A-A11) 05 Special Instructions/Note: <br /> a O <br /> 5724 HALL(720-32521-3) 12/28/10 11.29 Water X N <br /> Pacific <br /> N <br /> ... ....... <br /> I I lei <br /> cr3 <br /> d <br /> n� <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> ©Non-Hazard =Flammable ©Skin Irritant © Poison B © Unknown Radiofogical Return To Client ©Disposal 8y Lab Archive For Months <br /> Deliverable Requested:I,ii,III,IV,Other(specify) Special Instructions=Requirements: <br /> Empty Kit Relinquished by: Date: Time: method of Shipment: <br /> Relinquished by: Date/time: Company Received by: Datefrime: Company <br /> Relinquished by- Date/time: Company Received by: Daleffime: Company <br /> Relinquished by: DaleMme: Company Received by: patefiime: Company <br /> Custody Seals,(rliaci Gitstody Sea4 hlo CogioTerttperatlkre(s) GBnd Other.Remarks <br /> _ :: <br />