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Test menta4 E.Cooley <br /> Ave to A, Wine,CA 92814 (949)271-1622 FAX(909)260-3297 <br /> t 014 51 Cooley cite Suite A,Calton,CA 92324 (909)370-4687 FAX(908)370-1046 <br /> CHAIN OF CUSTODY FORM 9830 South520 E.Sunset Rd B-120,PVag..,,NV 850"9120 (400)786-0033 FAX(480)798-0621 <br /> 2620 E.Sunset Btl.C3,Lea Vegee,NV 89120 (702)799-3620 FAX(702)790-362t <br /> THE LEADER IN ENVIRONMENTAL TESTING (r/�q)t/`//I. </��/ I <br /> TAL-0019(1007) /L/.{I.4D— / 0 Page of <br /> Client Name/Address: Project/PO Number: Analysis Required <br /> Sit:f<n AeZT�4 � <br /> Fis-' r vwxvoa- 411t, ?ko 4It"S <br /> tt W,& 1 <br /> Project Manager: Phone Number: '4 7 <br /> --Ip,r,✓ wxk4PL <br /> Sampler: Fax Number: <br /> Ke" Gtctax,L4fSof ts9-9109 Y ) <br /> Y <br /> Sample Description Sample Container #of Sampling Sampling Preservatives <br /> matrix Type Cont Date Time Special instructions <br /> 6117" 1 IS' f JAO- y.l0.lt Sas go ✓ ✓ v <br /> f <br /> -3 9 4.1111a <br /> I <br /> (yXS ob` S t S•'d� ✓ ✓ ✓ ✓ <br /> ra <br /> GiP-S' 4r ✓ ✓ ✓ ✓ <br /> I <br /> I <br /> I <br /> i` <br /> Relinquished By: Date/Time: Received By: Date/Time: Turnaround Time; (Check) <br /> 7•��1�Z- /S,•00 same day 72 hours <br /> i <br /> Relinquished By: Date/Time: Received By: Date/Time: 24 hours 5 days <br /> 48 hours rm k <br /> Relinquished By: Date/Time: Received in Lab By: Date/Time: Sample Integrity: (Check) oC <br /> Intact on ice <br /> KNote: By relinquishing samples to TestAmerica,client agrees to pay for the services requested on this chain of custody form and any additional analyses performed on this project. Y <br /> 9-ayment for services is due within 30 days from the date of invoice. Sample(s)will be disposed of after 30 days. <br /> N f, <br /> n <br /> m✓: .i n. ::.rrm...r:.•p.,^...m....n .Ti• v ..r.-, n:v m,^�..�..;:•.;:: s...ns-i. ..-. . ': -.. > n. n .�. :.=r... r..ue ...:. . ..,v... .. .. v.... :]rTFTi.L.av�tA. "'T'.. :Arf.P...Fn-....n u. ...TllTA �. - nYn' <br />