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TestAmerica San Francisco 7 :5 "10 cS, TestAmenca <br /> 1220 Quarry Lane Chain of Custody Record <br /> Pleasanton, CA 94566 <br /> Phone(925)484-1919 Fax(925)600-3002 <br /> Samples Lab PM: Carrier Tracking No(s): COC No: <br /> Client Information (Sub Contract Lab) Sharma,Dimple 720-10875.1 <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 720-32521-2 <br /> Address: Due Date Requested: - Preservation Codes: <br /> 2795 Second Street,Suite 300, 12/30/2010 <br /> ,N A-HCL M-Hexane <br /> City: TAT Requested(days): 6-NaOH N-None <br /> Davis C-Zn Acetate 0-AsNa02 <br /> D-Nitric Acid P-Na204S <br /> State,Zip: E-NaHSO4 O-Na2SO3 <br /> CA,95616 F-McOH R-Na2S2SO3 <br /> Phone: PO#: G-Amchlor S-H2SO4 <br /> Ci -,< H-Ascorbic Acid T-TSP Dodecahydrate <br /> Email: WO#: ,N 1-lee U-Acetone <br /> J-DI Water V-MCAA <br /> K-EDTA W-ph 4-5 <br /> Project Name: Project#: r L-EDA Z-other(specify) <br /> Nestle-Ripon 72000256 0 <br /> Site: SSOW#: Other: <br /> F= <br /> U <br /> Sample Matrix fi v <br /> TType (" " o <br /> YP s-,ad U <br /> O <br /> Sample <br /> ple (C=comp o„ ern, mA <br /> ig. <br /> Nall <br /> uctions/Note <br /> Sample Identification-Client ID Lab ID Sample Date Time G= rab BT-T1 A Aer Special Instr <br /> 01 01” <br /> 12/28/1011:Pacf Water X(D 5724 HALL(720-32521-3) <br /> CO <br /> OIV .NO <br /> �( <br /> a� <br /> a,,; <br /> Possible Hazard Identification Sample Disposal(A fee may be assessed if samples are retained longer than 1 month) <br /> O Non-Hazard l=Flammable Skin Irritant Poison 8 Unknown Radiological =Return To Client O Disposal By Lab Archive For Months <br /> Deliverable Requested:I, II, III,IV,Other(specify) Special lnstructlons/QC Requirements: <br /> Method of Shi ment <br /> D) Empty Kit Relinquished by Date: Time: p <br /> O <br /> (D Relinquished by: Date/Time: Company Rec v by: Da Company <br /> !4-°g F-PS/-�j,WerCr <br /> W Relin ed by Daterfime Company Received by: Date/Time: Company <br /> C) 00 !Z-Zi-49 3 S`/ I ,4sw" <br /> O Relinquished by. Date Company R ed �I�XI7IO ( � Sq Q�JF� 4 <br /> [� `( 7 /�tU( r <br /> O <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperature(s)°C and Other Remarks: <br /> A Yes A Nc <br />