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❑ ❑ ❑ ❑ L e <br /> fi N <br /> TestAmerica San Francisco TQistmPinc-c� <br /> 12?0 Qtia�Py 1-ane N <br /> Chain of Custody Record <br /> 'HIn«ERPLj+IPl tN1'INL�4MET.FAL E517N:. <br /> 4lcasanton,CA 9451,6 <br /> phone 925 484 1919 fax 925 604)30u2 TestAtnerica Laboratories,Inc. <br /> Client Contact Project Manager: Binayak Acharya Site Contact:,Mark Czipka Date: COC Nu <br /> ECM Consultants Tel/Fax: (661)255-1693 Lab Contact:pimple Sharma Sampler; n1kok 7 __'2— oe _COOS <br /> 3525 Hyland Ave Suite 200 Analysis Turnaround Time Job No <br /> Costa Mesa,CA 92626 Calendar(C)or Work Days(W) C <br /> (714)662-2759 Phone T-4Tr£differamrro1nBe1— <br /> (714)662-2758 FAX ® ?week SDG No <br /> m <br /> Project Name Nestle <br /> as <br /> Site Ripon.CA <br /> P O# I day t <br /> o. <br /> m <br /> Sample Hur O <br /> Sample Identification Sample Date fame Pres. Matrix cwt- m Sample Specific Notes <br /> 110 H2O 3 X <br /> HCl €120 3 X <br /> �5: - 110 H2O 3 X No <br /> '— �g �; €1C1 H2O 3 X <br /> b� ` = HC'1 1120 3 X N <br /> 1g rn <br /> M-1- 6C.3- HCl I H2O 3 X <br /> HO H2O 3 X <br /> d <br /> HCI €i20 3 X <br /> HCI H2O 3 X <br /> HCl H2O 3 X <br /> YYl-1 j P� 110 H2O 3 X <br /> 1120 3 X <br /> Preservation used: 1=Ice. 2=IiCI; 3=t12SO4; 4=HNO3; S=NaOH;6=Other <br /> Passible Hazffrd Identification Sample Disposal(A fee maybe assessed if samples are retained longer than 1 month) <br /> ED Nr,n-Ncr_urJ ED I'l-mmuhle tiAin lrriuml I'urxa?R= I'11knemn =Return To Client ©Disposal By LabArchive ror Months <br /> Special InstructionslQC Requirements&Comments: REPORT DATA IN EDF FORMAT GLOBAL ID SL205012989 <br /> Relinquished byCi mpany Environmental Dateai c U Received by Company Tect,'_menta Date i <br /> In Cost Management,111c (do It LA I(1tv 1.13 <br /> Relinquished by Company Date im Rece ve v Company Gate/Time <br /> Relinquished by C'ompam Date/Time Received b% Company Date'I-ime <br />