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entrum Analytical Laboratories, Inca rum Job \`� <br /> Cent <br /> 20 <br /> 290 TENNESSEE <br /> REDLANDS, CA g237REET (909)798-96FAX(909)793-800) 9336 <br /> 559 Chain of Custody Re Ord <br /> �=' W Page,—_L of <br /> Anal ses Rec nested <br /> Project No.: <br /> [Project Name:15 <br /> a - C9) CT%?C )�7C) U E 0Turn-around time <br /> Project Manager: Fax: c <br /> Phone: F-1 24 Hr. RUSH' <br /> too5 Cera 7$^ ")��� a s ti K iS <br /> ti <br /> Client Name: Address: �»� - o a r 0 48 Hr. RUSH' <br /> (Company) 7 `,Yr u. °o 0 > m ❑ Normal TAT <br /> �A� i'�AAJ /JZC�ice., LJ/.LJl' /a��C'� �.4�iu�Qr D�C� m v ek m Cl c <br /> a •Requlr•s prly c�pprweJ, <br /> C) N uU atltlt"ural charges spPIY <br /> Centrum ID Sample ID Date Time SampleContainers: °0 a" of <br /> Site location ii w o p 8 Remarks/ <br /> (Lab use Duly) {.4s it should appear on report) sampled sampled matrix #and type <br /> U 0 Eo °O u m = m Special Instructions <br /> f9 W as v rq J q <br /> Z �w it Il�ys <br /> 35 <br /> � x <br /> iy:55 <br /> , u x <br /> Re' uishe by'{Samper's Signa re) Date Time Relin uished b <br /> - � 7 9 T. bate Time <br /> To be completed by laboratory personnel: Sample Disposal <br /> fRecei ed by: Date Time Received by: Date Time Samples chllled? Yes Cl No <br /> Custody reals? 0 Yes No ❑ Client will pick up <br /> Relinquished by; Date Time <br /> The delivery of samples and the signature on this chain of custody form All sample containers Intect7 Yes ❑No ❑ Return to client <br /> constitutes authorization to perform the analyses specified above Under <br /> the Terms and Conditions set forth on the back hereof, Received for Laboratory by: Date Time ❑Courier Cyi1 lFed Ex Hand carried <br /> l !o YY r! / M Lab disposal fee$5 <br /> Laboratory Notes: <br /> Sample Locator No. <br /> White Copy-Cdpe nai(Accompanies Samples) Yellow Copy-Centrum Files <br /> Pink Copy-Client Copy <br />