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Enviro-Chem, Inc. Laboratories <br />Turnaround Time Q e Day <br />X', <br />Misc./PO#- <br />1214 E. Lexington Avenue, <br />Pomona, CA 91766 <br />0 48 Hours <br />0 ,a Hogg <br />w <br />z w z 0 <br />r <br />Tel: (909) 590-5905 Fax: (909) 590-5907 <br />0 1 Week(Standard) <br />Q Cr o jr ;' <br />CA -DHS ELAP CERTIFICATE #1555 <br />Other: <br />z <br />o Cr <br />�; q <br />_- <br />x <br />Cr <br />U- w w <br />0 � w <br />z w a Analysis Required <br />COMMENTS <br />SAMPLE ID <br />LAB !�' <br />SAMPLING <br />DATE TIME <br />' ti! r4 <br />y7 v <br />y <br />Y/ <br />i <br />-- <br />o <br />1all <br />CD <br />_ <br />M <br />z <br />� <br />Glx <br />Company Name: <br />Project Contact: <br />Sampler's Signature: <br />V <br />Tel: <br />/ <br />Pr eject Name,1D• <br />Address: 1 j <br />CityiStatelzip <br />F xi€ L •� <br />Gl Z- �Gii S ,� <br />Relinquished by: <br />Received �h$�,:,i!": <br />f -' <br />Date &Tim p/.' . tractions for Sample <br />Storage After A__ nalysis: <br />RelinquisLd*1-- �' — _ <br />Date & Timev2 �3y— Dispose of 0 Retum to <br />0 Other: <br />Date & Time: <br />Client O Store (30 Days) <br />Received by: <br />Received by: �, <br />Relinquished by: <br />Date- <br />CHAIN OF CUSTODY RECORD <br />WHITE WITH SAMPLE - YELLOW TO CLIENT <br />Page _/—of I <br />