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SunStar Laboratories, Inc. Chain of Custody Record <br /> 3002 Dow Ave., Ste. 212 <br /> Tustin, CA 92780 <br /> 1-800-781-6777 <br /> Client: f e rC-4 Z:�7M r Date: Page: Of r <br /> Address: /c'� %'`` ( ✓�'f f A ��.11 /ick. ff e /aV Project Name: c /(-( e <br /> Phone: -716- ��� " fi� UG Fax: d 30 7 Collector:—&'c-t\ 4�0— t iC6 Client Project#: d,y <br /> Project Manager: yi Y !� �'L' Batch #: / Proposal #: <br /> U) <br /> c U) <br /> a m <br /> Q N <br /> U <br /> ON N <br /> V-1M .� <br /> m 6 C5 <br /> O OC <br /> _ r` r0 O <br /> O O O O O O U <br /> N CO I1- W O76 <br /> p <br /> O O N N O O O O <br /> Sample Container Q Q Q Q Q Q Q Q Q <br /> Sample ID Date Sampled Time Type Type w w w w w w w w w —J I Cl- Comments <br /> !C 4)v ./UI0 -4 04� viii G <br /> i <br /> u G <br /> .rYc /TG - <br /> /T 0q- 1 <br /> l0 >r< <br /> Vc k <br /> e3 AI/ 7e / <br /> Q -I7 01 �`i�` <br /> Relinquished by: (signature) Date/Time R wed by: (sign Date/Time Total#of containers J Notes <br /> Chain of Custody seals Y/ �,j <br /> Relinquished by: (signature) Date/Time Received by: (signature) Date!Time Seals intact?Y/NZ <br /> Received good condition/ of _j C <br /> Relinquished by: (signature) Date/Time Received by (signature) Date/Time <br /> ime:STurn around time:— <br /> Sample <br /> ample disposal Instructions Disposal n $2.00 each _ Return to client Pickup <br />