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A� <br /> CENTRUMANALYTICAL LABORATORIES,INC. <br /> 290 TENNESSEE STREET • REDLANDS, CA 92373 • (909)798-9336 I <br /> CHAIN OF CUSTODY RECORD PAGE OF <br /> Job No.: Project Name: Analyses required <br /> s 0 rain O <br /> Sampler: Phone: <br /> Client Name: Address: `jot 7 5 0° ey0 <br /> t V/ N ENT 7S V,91cl <br /> Sample Type # and <br /> Sample Date/Time z Site Location type of {� <br /> Number Sampled containers <br /> b r iners <br /> Remarks <br /> p and observations <br /> Z 3/ E S <br /> HA 2- A '1 1 y Z1,(P1-A-)-AAV alJP <br /> Re J d (Signature), Date/Tme R c e� (Signa Relinquished by (Signature) Date/Time Received by (Signature) <br /> � ��� VK <br /> Rehn uished by (Signature) Dat !fi Se d for Labor t y. Date/Time Samples chilled Yes C NO <br /> e) <br /> Samples sealed Yes )(No <br /> Method of Shipment <br /> The delivery of samples and the signature on this chain of custody form ❑ Courier ❑ UPS/Fed-x ❑ Mail Hand Carried <br /> constitutes authorization to perform the analyses specified above under <br /> the Terms and Conditions set forth on the back hereof. <br />