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M M M MM M M M s > � ~ hof <br /> SOUTHLAND TECHNICAL SERVICEJWC. <br /> CHAIN OF CUSTODY RECORD Lab Job Number _L 64 !2d l� <br /> Client Analyses Requested T AT Requested <br /> ❑ Rush 8 12 24 hours <br /> f r b W ❑ 2-3 days -Normal <br /> Address <br /> �i - �`U ✓ Sample Condition <br /> jeoItAftentionnj4 Phen Fax Sampled by o <br /> ,Vq �/ WX a O billed .Intact <br /> t Site ! �i H <br /> 13 Sample seals <br /> Pm ect NaznPr ec <br /> h La f cq o U <br /> �tYPe* N �? > X Remarks <br /> No <br /> Sample Collect 0 <br /> Client Lab Matrix Sample & size of �, �, a MO o <br /> Sample ID Sample ID Date Time Type Preserve container � o 00 00 00 00 <br /> AA�.1 � e5Sri <br /> Ica, I-AI-6 til >L <br /> /J Stj L f' AA ICW) . - <br /> - sto5 <br /> )4 <br /> r <br /> �.G I-Am <br /> W a ' �C <br /> IACD- ` 5 ' °1.0.5 3� �� I. <br /> W <br /> 'Cle <br /> Co to b <br /> Company Container types — etal Tube <br /> Rehnqui � _ � A=Air Bag P=Plastic bottle <br /> Com an G--Glass bottle V=VOA vial <br /> Relinquished <br /> Company to Time !Rec7eiedby p y <br /> out an ec ervtces, nc ole amp es are iscar a ays a er resu is are reporte un ess 011161 arrangements are <br /> made Hazardous samples will be returned to client or disposed of at client's expense <br /> 7801 Telegraph Road, Suite L & K Tel (323) 888-0728 <br /> WRITE RITE with report, PINK to courier <br /> Montebello, CA 90640 Fax (323) 888-1509 <br />