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a ALPHA SCIENTIFIC CORPORATION <br />CHAIN OF CUSTODY RECORD <br />r <br />Page of <br />Lab Job Number lQ711, <br />r <br />Client: t <br />Analyses Requested <br />T.A.T. Requested <br />Rush 8 12 24 firs <br />0 2-3 days o Normal <br />Address i��rc�N p0 lVF_ S U lT1✓ 3 Ute S FA SkOF/✓A (,� q r tl� D <br />ZIP 0 FIVNYI <br />f <br />; • <br />Report Attention <br />Phone <br />Fax <br />Sam I d)b <br />Sample Condition <br />w <br />r <br />hiltedntact <br />Project Name/No. <br />Project Site <br />/�(? 1 t� �?.�y011 )1 S, t,;lt Jt1,U L„! i S, -i .i7)�1� <br />2 <br />C7 <br />G1 <br />�m <br />o <br />p <br />> <br />O <br />> <br />a <br />t <br />— <br />� <br />0 Sample seals <br />Sample Collect <br />* <br />No.,type <br />Remark <br />Client <br />Lab <br />Matrix, <br />Sample <br />& size of <br />o <br />o <br />NN <br />Date <br />Time <br />Sample 1D <br />Sample ID <br />Type <br />Presery <br />container <br />°' <br />°° <br />°° <br />°° <br />�U71zt'1 <br />i <br />Dt <br />i <br />!A It I <br />� <br />iv R��. P. <br />C J t. C i•1 . W !” <br />X <br />ELL- <br />P' <br />Relin�(uish d y� Company , <br />`f <br />Date <br />, <br />Time <br />tl? <br />Received by r j C mpany <br />L-� 6. <br />Date , <br />b�C�f� <br />Time <br />J2 <br />Contaurertypes: M=Metal Tube <br />\ �_ <br />-4r <br />F t <br />//��" <br />A=Air Bag P=Plastic bottle <br />Relinquished by Company <br />Date <br />Time <br />Received by Company <br />Date <br />Time <br />G=Glass bottle V=VOA vial !I <br />I <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 />t1-4— r A 00701 Fnx (562) 809-8801 Distribution: WHITE with report, PINK to courier. <br />