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aY' <br /> CHAIN OF CUSTODY RECORD <br /> ,.tient name <br /> EIC Lop tJumaa+ <br /> ti <br /> 1 Jab number � <br /> '3p`Lf Anal;;cs required 5' <br /> .- 'roJttt a .i - t <br /> roiec:man.per 3 a <br /> ample Date Time* <br /> t <br /> composite <br /> cumber ampled sampled of .Sample description Number <br /> c. ([�� a., <br /> � Grab� _ e;,ntcincrs +KJ �ti� �� Re-arks <br /> i <br /> I <br /> I <br /> I <br /> I <br /> Y � A <br /> - Signature <br /> Rrlinq ..ned by <br /> Company pate Time <br /> Received by <br /> �ttiJia > :55 G I, F Btf <br /> Relinquished by <br /> Received by ; <br /> Relinquished by <br /> Received by <br /> BROWN AND CALAWE.LL Analytical Laboratories <br /> ❑1Q','d Powell Street,Em' Note* Samples are discarded 30 days ef;er results are reported <br /> eryville, CA 94608 14151 428.2300 unless other arrangements are made, <br /> a <br /> (� 371 South Fair,Oaks gvenue, Pasadena.CA 91105 12131 681.4855 Hazardous samples will be returned to client or dleposrd <br /> li <br /> t_1 <br /> ant expense r <br /> $ <br /> 1 <br /> I <br />