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a ALPHA SCIENTIFIC CORPORATION <br />1490 CHAIN OF CUSTODY RECORD <br />I Report Attention <br />f <br />Analyses Requested <br />Fax <br />Sampled by <br />C <br />0 <br />�I♦ <br />y <br />U <br />_ <br />Project Site <br />R <br />C7 <br />Y <br />[] <br />i <br />W <br />ID <br />m <br />O <br />04 <br />> <br />m <br />O <br />O <br />> <br />o <br />y <br />r <br />Sample Collect <br />No.,type* <br />Lab <br />Matrix <br />Sample <br />&size of <br />O <br />O <br />N <br />N <br />N <br />� <br />(� <br />:Ee]:Time <br />Sample ID <br />Type <br />Presery <br />container <br />°° <br />x <br />x <br />x <br />°° <br />`- <br />I Report Attention <br />f <br />Phone <br />Fax <br />Sampled by <br />Project Name/No. <br />Client <br />Sample ID <br />t <br />r (I <br />Page _of <br />Lab Job Number &7c2 -t, <br />d . <br />Rush 8 12 24 hrs <br />2-3 days ❑ Nonnal <br />hilled '4 Intact <br />Sample seals <br />Remark <br />!.!, NV i,. <br />Uate f mle <br />Relinquished by,� i Company Dale Time Received mom an} 1 Container types: M=Metal Tube <br />s A=.Air Bag P=Plastic bottle <br />1 Relinquished by Company Date Time Received by Company Date Time Glass bottle V=VOA vial <br />1 <br />'Alpha Scientific Corporation Note: Samples are discarded 30 days after results are reported unless other arrangements are <br />16760 Gridley Road Tel: (562) 809-8880 made. Hazardous samples will be returned to client or disposed of at client's expense. <br />e -o_:._ r e on701 FAY. (562) R09-9801 Distribution: WHITE with report. PINK to courier. <br />