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CAL JECII Environmental Laboratories Lab lob No � Page / of <br /> 6814 Rosecrans A-,enue, Paramount,CA 90723-3146 <br /> N Telephone (562)272-27M Fax (562)272-2789 a <br /> }_— Chain of Custody Record o <br /> CD Client ` Phone and Time <br /> Contact L,It VC Seri) I,e Lax 714 6G 7 ,:Z3/ O Rush X <br /> �v Address " 1 fg r k< ,4,r Z.)r, 1+lormal <br /> NS rin 4k, ., e- eft 9 z 70 <br /> Project -- Anal Requested <br /> f <br /> Sampled By <br /> Nei azure <br /> Lab ID Number Field ID Datefl'tme Sampled Bothe Type No Preserti Mainz Comments <br /> x X x X <br /> 1 Z1,7103 10 <br /> v 5 P <br /> w <br /> 3 4S x <br /> i <br /> `c x x !x A <br /> N <br /> ro KCILaquisltcd 1 e= Date/T)me Recerkod <br /> m <br /> Dispatched Date/Time Carrier <br /> U i hereby autbonze the performance of the above indicated tests <br /> Date/Time / '� r,' - �I Received by I , J <br /> rrEtzcp OW Custody seal(:}in Met upon receipt by lab? <br /> YES NO NONE <br />