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E a's e c o p.=•�or_ <br /> CIIAIN-OF-CUSTODY RECORD <br /> tlrelll f patt�5ii,�ed C,rrier <br /> ne Air1:i11'�o. Coder NO. <br /> V <br /> �SliIP TO: SEND RESULTS TO: <br /> Ecseeo-Cal Lab client\•ma <br /> 2544 Industrial Blvd. Cc:n-,•ry <br /> West Sacramento,CA 95691 Ade-e.. !^ ' t r"i ' '.`�:( 1.- fit; <br /> (916)372-1393 ;c C tit L l t: r .: I <br /> ATTENTION: Phc.^.e <br /> PRO.IECTNAME l� rn° �71:i) -� ��i�t� PROJECTSO. ZL'7yr� P.O.\O. <br /> Relinquished by:(Signature) Received by: (Signature) Date Time <br /> r <br /> Relinquished by: (Sigfalure) Received by: (Signature) Date Time <br /> Relinquished by: (Signature) Received at fab by: (Signature), Date Time <br /> `-Relinquished from lab by: (Sigrarure) Received by:(Signature) Date Time <br /> W. ANALYSIS REQUEST <br /> Sample ID Sample Date/Time Sample Condition <br /> --' \'umber Description Sampled Analysis Requested Upon Receipt <br /> I 277�b i F'I-!/ 11 I Z11, '� <br /> Special Instructions/Comments: 5,., A91,';S RECEWED <br /> IN CCs''6 rpNDITION <br /> CE✓5�'ODY :LAL INTACT <br /> NO • 'ti D JI0,4S QF IrQj�I-At]EJE411S SAhiPi.F� 11'lI L TIF R1YT 7RNF.D TO CLIENT <br /> cctcd <br /> Anil lytical Immediate <br /> .mor.A.T's: Attention (2Do% iumwge) RUSH (so•100s6 surch•rie) Standard <br /> Cal Lab ID Number: (for lab use only) <br /> tri ' <br /> Client Retsina White Copy Only (R.ri•ed 1/J r) <br /> - f <br /> C OWDUCTIM OF 11H,S <br /> DOCUMW CAMW3E <br /> IM"M DM TO! TSE <br /> COIDITION OF THE ORIGINAL, <br />