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MO C"MAVc UM B aTATT O S s »L Gtttttttttltll itt� tttttttttt�I ittttttttt�I tit�l tttttttttt�l t� till �� <br /> 806 N Batavia o Orange CA 92868 C• CHAIN OF CUSTOD&COiRD <br /> (714) 771-6900 c FAX (714) 538-1209 l <br /> Date ( z Gd Page of <br /> CLIENT �0 =1_1 0{2t <br /> �ADDRESS 67 �(rEN ZG�IZ Z� ATE 2Zv I PROJECT MANAGER r <br /> Samples Intact Yes No <br /> � �( 2–\ P ONER County Seals Intact Yes✓{�<' No <br /> �� ��d Sample Ambient_ Cooled`'i Frozen <br /> PROJECT NAME SA L RS {S+gnatu Same Day 24 Hr <br /> Regular '< 4$ Hr <br /> �CAr-T12PtNS S iTSCC Sh�.,?C��'JC V i <br /> SANIPLF TYPE <br /> SAMPLE LOCATION unTF T nE – – — - NO Or SUSP <br /> NUMBER DESCRIPTION VV/,TEA oFA SOLID CNTNR, CONTAM TESTS <br /> REQUIRED <br /> 926a v <br /> a <br /> I <br /> i <br /> i <br /> Reli q shed by (Sign t re) Received by (Signature) Date/Time I hereby authorize the performance of the above <br /> indicated work. <br /> R linquishedy (S nature) ry o alystt /Time <br /> (Sill u <br /> Special Instructions <br /> DISTRIBUTION White with report Yellow to AL <br /> Pink to Courier <br />