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1 <br /> TestAmerica San Francisco <br /> S D �- -� TestAmenca <br /> Plea Quarry lane Chain of Custody Record <br /> Pleasanton, CA 94556 <br /> Phone ;- <br /> (925)484-1919 Fax(925)600-3002 <br /> Sampler: Lab PM: Carrier Tracking No(s): CCC No: <br /> Client Information Sub Contract Lab Sharma,Dimple 720-4669.1 _ <br /> Client Contact: Phone: E-Malt: wage. <br /> Shipping/Receiving dimple.sharma@testameriCainC.com Page 1 of 1 <br /> Company. Job#: <br /> TestAmerica Laboratories,Inc Analysis Requested 720.18915-1 <br /> address: Due Date Requested; - Preservation Codes; <br /> 885 Jarvis Dr., 4/2212009 A-HCl, nn-Hexane <br /> City: TAT Requested(days): B-Na0H N-Mone <br /> Morgan Hill C-Zn Acetate 0-AsNaO2 <br /> State,Zip: D-Nitric Acid P•Na204S <br /> CA,95037 F-NaHSO4 0-Na2SO3 <br /> Phone: PO F-M60H R-Na.2S2SO3 <br /> G-Amchior S-H2SO4 <br /> v ra v H-Ascorbic Acid T-TSPDodecahydrate <br /> Email: WO MLn <br /> 1-Ice U-Acetone <br /> P "Q` a n J-01 Water V-MCAA <br /> y "Zi A O <br /> Project Name: project } -EDTA w-ph a-5 <br /> 'G' Lj a; <br /> Nestle Ripon 72000256 d mi w EDA z•other(specify)0 <br /> Site: SSOW#: = Z U Other. <br /> a <br /> Z <br /> I Sample Matrix E <br /> ype (werer. '—' x Z 2 <br /> Sample (C=comp, o„�f�;ix v_ 'jEr m m <br /> Sample Identification-Client ID Lab ID Sample Date Time G=grab erten:suo,n�o- E a w12 Special Instructions/Note: <br /> Preservation Code: <br /> (�( 7501 KIERNAN 2008 EFF(720-1$915-1) 417109 15:10 Water X X 4 S � <br /> Cz 7501 KIERNAN 2008 MID(720-18915-2) 417109 15:15 Water X X 4 <br /> tU <br /> b3 7501 KIERNAN 2008 INF(720-18915-3) 417109 15:20 Water X X 4 t0 <br /> TS D40709(720-18915-4) 417109 Water -3 <br /> 3 v uT3St� <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 Radiological =Return To Client =Disposal By Lab © Archive For Months <br /> Deliverable Requested:I,Il,III,€V,Other(specify) Special Instructions[QC Requirements: <br /> Empty Kit Relinquished by: Data Time: Method or shipment: <br /> Relinquished by: �g�'T rpeq Oo pan Received by: t 1 Date m S Comps_ by .__! <br /> Z e �rt� <br /> Relinquished by: Datemme: Company Received by. oaterrime: Company <br /> Relinquished by. Oate/Time: Company Received by Oateffirne: Company <br /> �C stony Seals Intact: Custody Seal No.: Cooler Temperatures)°C and Other Remarks: <br /> Yes A No <br />