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i P <br /> `MOO 00748 <br /> Mggr.en <br /> CHAIN OF CUSTODY RECORD <br /> Sampler- Rckyric, Date Shipped: Carrier: 1 <br /> Telephone: Airbill Number: Cooler: <br /> SHIP TO: >< SEND RESULTS TO: ` <br /> McLaren Analytical Laboratory <br /> 1 1 101 White Rock Road �} Client Name: <br /> Rancho Cordova.CA 95670 MAR <br /> r Yni <br /> (916)638-3696 <br /> MaR 2 5 199� Company: `� <br /> N�� i � `'�,,}-�SAL HEALTHAddress: a L -Q�57 <br /> PERMIT/SERVICESPhone:�6� 36$ -6,1 S <br /> PROJECT NAME: ►^S PROJECT#: <br /> LABORATORY PROJECT(LP)#: P.O.#: <br /> Relinquished by:is w Received b :rs�rm+um) Date. _l Time:'31,00 <br /> OO <br /> J ✓ <br /> Relinquished by:(sq ­i Received by:�s�raium Date: Time: <br /> Relinquished by:is.g.... i Received At laUb :(s, R Date: Time: <br /> 10zZI 8 I o <br /> ANALYSIS REQUEST <br /> Sample ID Sample Type of Numberof <br /> Plumber Description Datef ime Analysis Requested T.A.T. Container Containers Lab 1D <br /> O 39 r0®) <•a 3.5� n r• $r L5 V <br /> s ' sem" O.�s YP46) 9 . ATX'E �4 zr9 <br /> 5,O'P-+- <br /> o�Q oa 3_ t sP t i 3 -r x —�-- 3).19]A g,. <br /> Special instructions/Comments: <br /> Sample Condition Upon Receipt: <br /> Expected Analytical Turn-Around Times: <br /> Laboratory Disposition: /q `3 q Secure_c <br /> I=Immediate Attention: 2=Rush: 3=Standard: 4=Standard: Storage Refrigerator ID "► Yes a_( <br /> 24 hours 48 hours 1 week 2 weeks Storage Freezer ID No--- <br /> McLaren Analvtical Laboratory 11101 White Rock Road.Rancho Cordova, CA 95670 916.638.3696 <br />