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Z� <br />L <br />Calscience Environmental Laboratories, Inc. <br />❑ SoCal Laboratory ❑ NorCal Service Center <br />7440 Lincoln Way 5063 Commercial Circle. Suite H <br />Garden Grove, CA 92841-1427 Concord, CA 94520-8577 <br />(714)895-5494 (925)689-9022 <br />CHAIN OF CUSTODY RECORD <br />Date 3� (. / � 8 <br />Page ( of <br />LABORATORY CLIENT: <br />CLIENT PROJECT NAME / NUMBER: <br />� CIKJYV�i <br />1 \ I c.,.J <br />P.O. NO.: <br />ADDRESS: ' / C" <br />74 <br />NcsS / 'j0. <br />PR ECT CONTACT : <br />(o p N �.{.CJf,}C. / V <br />CI STATE <br />// <br />r c e— 1..1 <br />v�- <br />///SAMPLER(S): (PRINT) <br />�VV' I <br />COELT LOG CODE <br />COOLER RECEIPT <br />°C <br />TEL: '2 /O B <br />E-MAIL: <br />//, _ �v{I p. <br />U <br />`V �'r{L <br />TEMP= <br />TURNAROUND TIME' <br />❑SAME DAY ❑24 HR ❑48 HR ❑72 HR DAYS 0 1 DAYS <br />REQUESTED ANALYSES <br />SPECIAL REQUIREMENTS (ADDITIONAL COSTS MAY APPLY) <br />❑RWQCB REPORTING FORMS ❑COELT EDF ❑ <br />Cd <br />'d <br />SPECIAL INSTRUCTIONS: <br />ZZ� <br />O <br />13V <br />O <br />ICONT. <br />"a <br />m <br />o <br />O <br />a <br />moy <br />.i <br />> <br />FUO <br />I/rE <br />USE <br />SAMPLE D <br />FIELD POINT NAME <br />SAMPLING <br />DATE TIMEC <br />oN <br />(FOR COELT EDF) <br />6 <br />> <br />K aCov� r <br />3 <br />9W <br />Reli i hied by: (Signature) <br />Received by: (Signature/Affiliation) <br />Date: <br />Time: <br />Relinquished by: (Signature) <br />Received by: (S nature/ARliation) <br />Date: <br />Time: <br />Relinquished by: (Signature) <br />Received by: (Signature/Affiliation) <br />Date: <br />Time: <br />DISTRIBUTION: White with final report, Green and Yellow to Client. 10/01/07 Revision <br />Please note that pages 1 and 2 of 2 of our T/Cs are printed on the reverse side of the Green and Yellow copies respectively. <br />