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TestAmerica San Francisco <br /> 1220 Quarry Lane Chain of Custody Record 70 TestAmericaPleasanton, CA 94566 ! <br /> Phone(925)484-1919 Fax(925)600-3002 x a t.e�rsrra{ra vrrz y ar�crrrnd oris r;F,e; <br /> Sampler: Lab PM: Carrier Tracking Nota): COC No: <br /> Client Information Sub Contract Lab Sharma,Dimple 720-4724.1 <br /> Client Contact: Phone: E-Mail: Page: <br /> Shipping/Receiving dimple.sharma@testamericainc.com Page 1 of 1 <br /> Company: Job 4: <br /> TestAmerica Laboratories,Inc Analysis Requested 720-18980-1 <br /> Address: Due Date Requested: ,.Preservation Codes: <br /> 4/22/2009 A-HCL M-Hexane <br /> City: TAT Requested idaysl: <br /> B-NaOH N-None <br /> G1111111111=- k iiC-Zn Acetate O-As1daOP <br /> State,Zip: D-Nitric Acid P-Na2O4S <br /> E-NaHSO4 0-Na2503 <br /> Phone: PO F-Ml H-Ni <br /> 9� w H-Ac S-H2SO4 <br /> H-Ass Ascorbic <br /> Acid T-TSP Dodecahydrate <br /> Emaii: WO it I-Ice U-Acetone <br /> a, J-DI Water V-MCAA <br /> Project Name: Project#: NP <br /> K-EDTA W- h 4-5 <br /> Nestle-Ripon 72000256 p L-EDA z-other(specify) <br /> Site: sS0 W pr 2 Other: <br /> F <br /> U <br /> Q <br /> Sample Matrix cc <br /> Type (w=weer, o <br /> s-.Dote, <br /> Sample (C=comp, m <br /> NSam le Identification-Client ID Lab ID Sam le Date Time G= rob er-rrebue,*,t r0n 1 1 1 1 1 1 1 1 1 Special Instructions/Note: <br /> (D <br /> Ln <br /> to 110 MANLEY(720-18980-1) 417!09 11:40 Water X 0� <br /> 0 361 PARALLEL(720-18980-2) 417109 11:50 Water X OL <br /> tfi <br /> N 501 PARALLEL(720-18980-3) 417/09 11:45 Water X 0 <br /> Ln <br /> RC-1 (720-18980-4) 417/09 10:52 Water X <br /> 4 <br /> E UCE <br /> mp er <br /> 111111i lisle r 1. , I <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 0 Skin Irritant Poison 6 © Unknown Radiological I=Return To Client =Disposal By Lab Archive For Months <br /> Deliverable Requested:I,II,III,IV,Other(specify) Special Instructions/QC Requirements: <br /> Empty Kit Relinqui d by: Date: Time: Method of Shipment: <br /> Relinquished by: Datsltii i Co an Received by: DateMme: Company <br /> rt � <br /> Relinquished by. D Rme: Co any Received by: Datefrime: Company <br /> Relinquished by: Daterrme: Company Re ived b_ `� DateMoloompany <br /> t lfr� n•+ 1 /L� Ili 1207 <br /> Custody Seals Intact: Custody Seal No.: Cooler Temperaturl oC and Other Remarks: <br /> A Yes A No <br />