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OL ALPHA SCIENTIFIC CORPORATION <br />CHAIN OF CUSTODY RECORD <br />Page I of 1-- •- <br />Lab Job Number 1 --rI2 <br />Client: <br />EtWM �(hFNTPtL hf ni tenoW <br />Analyses Requested <br />T.A.T. Requested <br />❑ Rush 8 12 24hrs <br />Noral <br />o 2-3 days �rm <br />Address <br />21136 NVA/T1NlrTilN bR\vC .Tv1iF 36 S.Pfts/wF,11o3 <br />F <br />o <br />°O <br />0 <br />o <br />`° <br />v <br />CIO <br />o <br />W <br />m <br />o <br />N <br />oO <br />p <br />> <br />0 <br />N <br />oO <br />O <br />> <br />0 <br />N <br />°° <br />U <br />j <br />o <br />1— <br />Report Attention <br />Eb TQ sn—,Z <br />Phone <br />l 61A) )-q9 <br />Fax <br />(62,L) }9 q S►3T <br />SaT1 <br />b <br />Sample Condition <br />a Chilled ❑ Intact <br />11 Sample seals <br />ProjectName/No. <br />Project Site <br />/k2to �Z. (,gs' 130 f, W11-SOA)wnY STDGkTON <br />Client <br />Sample ID <br />Lab <br />Sample ID <br />Sample Collect <br />Matrix- <br />Type <br />Sample <br />Presery <br />No•,type* <br />& size of <br />container <br />Remark <br />Date <br />Time <br />D3 <br />11-ls-03 <br />ILq <br />F <br />1 -Ly3' M <br />F <br />3• N <br />Itis <br />N FaK <br />►J3- 3•s � � <br />`-� <br />1 <br />3 <br />W <br />-3 � N <br />•�� <br />IH � <br />2 - I <br />11413 9 <br />i <br />Rclinqu ed b Company <br />VA � <br />Date <br />t� 1 <br />Time <br />Received by Company <br />t <br />Date <br />`� —p <br />Time <br />jr <br />Container types: M=Metal Tube <br />A=Air Bag P --Plastic bottle <br />G=Glass bottle V=VOA vial <br />Relinquished y Company <br />Date <br />Time <br />Receive by Company <br />Date <br />Time <br />Alpha Scientific Corporation Note: Samples are discarded 30 days after results are reported unless other arrangements are <br />16760 Gridley Road Tel: (662) 809-8880 made. Hazardous samples will be returned to client or disposed of at client's expense. <br />fl -4— fl A nn-rnz Fav• Rtl4-RRnI Flictrihotion• WHITF with renort- PINK to courier. <br />