Laserfiche WebLink
Performance Analytical Inc. 20954 Osborne Street <br /> Y Canoga Park,California 91304 Chain of Custody Record <br /> -� Environmental Testing and Consulting Phone 818709-1139 <br /> Fax 818 709-2915 Analytical Services Request <br /> Client/Prosect Name Address/Phone PAI Protect No <br /> 2130 KYLE cHx,,Sre— ANALYSES <br /> �}R-C-o (iUTYb'Srr <br /> Prosect Location Client Protect No <br /> 7906 4912- 0 ST/L"--T 0*0 s'- 1/4 O y <br /> S ToAV A04A714 <br /> ContactSampler(Signature) PO No <br /> (40 10 <br /> � p <br /> Sam le Lab Type � 4N Expected <br /> Identlftca[lon No Date Time Sample No of Sample 1` q Turnaround Remarks <br /> Time <br /> S YS TEM — ,1►Fc.v6,0T g f lags- 3 ,oo v 0/ 79 A-10- 2-4 H,,s 1-7q Rsow-oia <br /> &YSTBm— EFFt-O"T 3 ZOpr4 19037Qf 39 <br /> I <br /> Relinquished by (Signature) Date Time R�we�y(Signature) Date Time <br /> �f Sl1v�gY <br /> �' n0 A r•' <br /> Relinquished by (Signature)i Date Time Received by(Signature) Date Time <br /> 0 •,�` <br /> Relinquished by (Signature) Date Time Received by (Signature) Date Time <br /> Disposal Method <br /> White Copy Accompanies Samples <br /> Disposed by (Signature) Date Time <br /> Yellow Copy Sampler <br />