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star a M Inc' S �ain of Culody�or M <br /> 326 Encinit Ivd, Ste 150 <br /> Encinitas, CA 92024 <br /> 1-800-900-9333 <br /> Client —� n G Date O Page Of <br /> Address / Lorte ci' �►'+ l4vQ ..S', Project Name r <br /> tA- <br /> Phone 20 — 9 - 2 2 Fax — - Z Collector_,��_ 6Z59ul ooQ/ <br /> _.���d YQg Client Pro ect# ��{< < <br /> Project Manager -T {'eu-] Ugy.. A He A& Batch# Proposal# <br /> m tr H c <br /> ocn <br /> o D 0 <br /> � p <br /> civ ti Co to ton CO o ` o m <br /> W OD C v COgCO cQo CD # <br /> Sample Container Q ¢ ¢ ¢ ¢ a d ¢ Q �� 0 w <br /> Sample ID Date Sampled Time Type Type LU w w w w is w u w � I CL I Comments <br /> VW10 2 <br /> or 4� C! t5 F 770 <br /> Relinquished by (signature) Date I Time Received by (signature) Date/Time Total#of containers Notes I <br /> Q 7711 D �r � � �S� Chain of Custody seals Y1NINA N —r �� 1 Me r V&`I8TEk <br /> Relinquished by (signature) ata I Time Recei�{ed by ign } Dat T me Seals intact?YINMA � � e acY��,�,q/t 5 <br /> 0,71 Jw I - 7 / Rocewed good condition/cold ' i-b e66t 42—T_ 8 E M 37 19 6 f <br /> Relinquished by (signature) Date l Time Receive by (signature) ate l lime ii TAM E't T15A, AL DCA <br /> Turn around time_ L�Q•t �� <br /> Sample disposal instructions Disposal @$2 00 each _ Return to client __ Pickup <br />