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m <br /> CAL TECH Environmental Laboratories Lab Jcob No. F*c J-0 � <br /> 6914 RUdecram Avenue, Paramount CA 90723-3146• <br /> nQi T'ctephonc: (562)272-2700 Fax: (562)272-2789 <br /> Chain of Custody Record <br /> 7 J <br /> Client � - - -- — 7t)C a l -Z3 J 0 "Tt"Around Tme <br /> Contact: :�� rcr iYf Fax: 7c�k G� 7-123[a Rm ✓ <br /> Addres: S�vcz! t s^ .(;tars lec Or`, -- Normal <br /> kampkd BY: zi <br /> Name<aignaiure <br /> Lab ID Number Field ID Date/Time Sampled BoMe Type No. Pmserv. Matrix Comments <br /> 7 <br /> M <br /> rq <br /> V <br /> W <br /> w <br /> V <br /> Q) <br /> m <br /> N <br /> .-1 <br /> T <br /> U <br /> W <br /> W <br /> �D EE <br /> v <br /> Relinquished Date 1 Time I t17`"1 3 :c7 c7 Received. <br /> D ispatcbed: Datc t Time, Carrier <br /> v <br /> m <br /> N 1 hereby authorize the perfatmance a[the above i ad tsM <br /> NC- <br /> Daw Received by rTime: —�=�3 !0:00� tali: <br /> m <br /> CTELCCR.DOC Custody scal(s)in tact upon receipt by lab? YES Nfl NONE <br />