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)IVERSIFIED ANALYTICAL SERVICES CHAIN OF CUSIOUY RECORD <br /> NVIRONNIENTAL LAISORAIORY 3732 W century Blvd. <br /> Phone: (310) 671.5346 Bldg. 1 Unit 3 � <br /> FAX: (310) 671-7216 Inglewood, CA 90303 Date: 6/12z- Page-_ox <br /> - <br /> Project NameXN C�4� <br /> Client: <br /> Project Manager �7: � � Phone,(6jy),425�7 M-3 <br /> Address: P D, <br /> Sampler Signat <br /> Sample Location Samp]. _ Type _ No. of Tests <br /> Number Description Date Time Liquid Air Solid Cntnrs Required <br /> Comp Grab <br /> I <br /> My 4 PW?)�a� o <br /> L + <br /> �(1• Z✓r �I fa��0 � ` � � y III <br /> y�� � � /,7,v,� ✓ 1 �r \ <br /> , <br /> /000 <br /> Y° 1i Il. r 11 <br /> IA ✓ , 1 <br /> Relinquished bys �f/ 9� Read by: Data Time <br /> Rellnqulshed / Rec'd by: <br /> Relinquished by: Reed bys <br /> Relinquished by: Recd for lab <br /> Method of shipments l L <br /> special Inatuctions: <br /> � a Ir � � � 1• � � r � ■rte r � ,� � a■■� srsl� <br />