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SunStar oratories Inc Chan of Gu dy Record <br /> 326 Encinitas Blvd, Ste 150 <br /> Encinitas, CA 92024 a <br /> 1-800-900-9333 - <br /> Client P iL A, J, r Date l2' gli- LlPage_ Of <br /> Address rt , Protect Name r4rMelf, <br /> Phone (7-4)9 i 4-; '1 ;' Fax . 57 s Collector A Client Protect# 54. owl <br /> Protect Manager ' ,M Awi Batch # 1A CK> Proposal# <br /> ,T <br /> N <br /> 41 <br /> ` N <br /> s N <br /> C r � <br /> U 2— in <br /> m M <br /> > Q <br /> 0 0 0 0 L0 LO o o Z <br /> N SD i- CO e— p (tf <br /> 12 <br /> Sample Container ¢ Q a ¢ ¢ a Q ¢ Q 0 v <br /> Sample ID Date Sampled Time Type Type LU UJ w w w w w w w � I n I Comments <br /> "'fir.? t �;1 ` i �- ` ' 0 � <br /> C )(1t tip. <br /> Relinquished by (signature) Date 1 Time Received by (signature) Date 1 Time <br /> ,.,.,..,.... � � Total#of containersTo, t� Notes <br /> 7` " 6 t Chain of Custody seals YININA <br /> Relinquished by (signature) Date/Time Received by (sl C e) Date 1 Time Seals intact?YININA ;-"Ft k i t i}� <br /> - TV Ila <br /> _f— Received good condition/cold t <br /> Relmquished by (signature)"` Date 1 Time RPteived y (sign#bre) - Date 1 Time f + t . <br /> Turn around time Sit "t <br /> Sample disposal Instructions Disposal @$2 00 each Return to client Pickup w <br /> i rY .� <br />