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J �� <br /> CENTRUM ANALYTICAL LABORATORIES,INC. �V2-� <br /> 290 TENNESSEE STREET REDLANDS, CA 92373 (909)798-9336 <br /> CHAIN OF CUSTODY RECORD PAGE °2 OF <br /> Job No.: Project Name: Analyses required <br /> Sampler: Phone: <br /> A '.4. JF-S1t41LZA- <br /> Client Name: Address: ,,(t /'✓ <br /> En <br /> /Ke <br /> a hm <br /> Sample Type # and <br /> Sample Date/Time Site Location type of �. �� ( <br /> Number SampledT3:AI <br /> Remarks <br /> r containers ,(J <br /> ONa o Csand observations <br /> rs Bs= Ifs- <br /> �, -S <br /> h1_0 Z— <br /> iV - <br /> 1� F7 - f x <br /> 10 E7-tV LD <br /> T 1$7-/-5- <br /> Re us d by: (Signature) Daterrime Received by (Signature) Relinquished by: (Signature) Date/Time Received by: (Signature) <br /> Relin is ad by: (Si nature) Date/Time Receive fo Lab story Date/Tim Samples chilled Yes ❑ NO <br /> (Signal re) �/ <br /> �Z 1 )v Samples sealed I Yes No <br /> Method of Shipment <br /> The delivery of samples and the signature on this chain of cust dy formCourier PS/Fed x C Mail C Hand Carried <br /> constitutes authorization to perform the analyses specified above under <br /> the Terms and Conditions set forth on the back hereof. <br />