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Del MarAnalytical <br /> C 2852411an Ave.Iry e.CA92714 (7141261.1021 FAX 17141251.1228 <br /> �i <br /> 10[4 E.Coorey 0r..5urte A.Cu![on.CA 92324 19091370-4667 FAX(909]$70-1046 - <br /> 16525 Sherman Way,Suite C-1 I,Van Nuys,CA 91406 (B 181 779.1844 FAX 10181 7790843 <br /> 2465 W.11th 51..5ul[e 1,Tempe.A2:as2B 1 16021965 0172 FAX(602)968-t538 <br /> CHAIN OF CUSTODY FORM <br /> Client Name/Address: .moi ri.G,4 Project/PO Number: <br /> GJ=�1 �}�� `�4W7- 0( 7 Analysis Required- <br /> IS 74 - 4-;t v <br /> equiredIS74 . 4-;tv <br /> Project Manager/Phone Number: Sampler: <br /> �r <br /> Sample Sample Container #of Sampling Preservatives <br /> Description Matrix Type Cont Date/Time I!} Special Instructions y <br /> 4b r^t tz-z�-q4 <br /> r YtdrtZ YOA <br /> r <br /> tlu-Z. <br /> z <br /> Relinquished y: Date(rime: Received by: Date/Time; } Turnaround Time: (check) <br /> efiri wished B '} A. `'' r, �' ! .! ,r {'r r same day 72 hours <br /> q y' Date/Time: Received by: +}Date/Time: 24 hours 5 days <br /> Relinquished By: Date/rime: 48 hours normal <br /> Received in Lab by: Date /Time: Sample Integrity: (Check) <br /> intact on ice <br /> Note: Samples)will be disposed of after 30 days. <br />