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E u s e c O ( ). . Peg._of — <br /> . <br /> CHAIN OF CUSTODY RECORD r `•�`1 i r' <br /> ('AMPLER: f <br /> -j- <br /> Ph... <br /> Phone (s 2g3 70-7 <br /> t �"' ,N'Mxxi FR iNl sfkv <br /> ..AtrbW No ' oolarN� iy <br /> . <br /> SS�ID�RS <br /> y., ,q��j9 sT �✓< - <br /> �,` ,Easeco-Cal Lab <br /> 2544 Industrial III d.,.- <br /> West <br /> West Sacramento, Mammo.. <br /> (916) 372-1393 1T'`L F n 5 ' ✓t' S <br /> :-:. ATTENTION:' r. Phan(, — <br /> d ¢ <br /> 'PROJECT NAME �OCLv/f/ PROJECT NO:�S�Xk73 lei 'p,O.N7-3 <br /> FM <br /> Relin ui fd• S' a r -- -^�--•",=*'''^Date - r"Time' <br /> IiecGj�ed hy.(»$ignature)- -+ <br /> Relinquish b : (Sign e) Received?by;(Signature), Date Time <br /> itkS <br /> Reltqquished by. y(Srgnature). fva a eceived lab( (Signature) 1 <br /> a <br /> b tFi qtt+ f ate Time <br /> Relinquished from lab by (Signature��-4" #teceiy y�(Signalure) eYy, � Dqt Time <br /> a <br /> kik, , w $pp •Nk s,..6 y, i �;n aF k ,.y� _ <br /> :r' <br /> AL IS REQUEST <br /> Sample ID _ Sample Date(Ttme11' Q1 �k+v Sample Condition <br /> :5 escri tion am led `z ' ' i .- — <br /> p p f; ,ty;rApalysls Requested , Upon Recekpt , <br /> r,.r.il'VO ;' <br /> �+Va t - <br /> , <br /> j,�d ,'�.r 'b+'ir'��.�*, <br /> 2R � �a x i k7.d�ls,.� ";T J+, rR.i�' „"� N`��.t���� T1Ri+S'1 '::`roti '(k.Y���•i-�V'��{n <br /> Erft <br /> � ,' s v �rc..��. .,ti. a ,.'WF�'typ � ,yx .�,� N'�ir • t ,1 r,M1K.y.er_ <br /> ~:a, y '!'l�"{, P'Q �FIRICVCIYGI�" !yxJ1"J"° ' itrbL. <br /> NDIlluff", <br /> ",Spedlal structions/Comments <br /> NOTF- UNUSED PORTIONS OF NON-AOUEOUS SAMPLES WILL BE RETURNED TO CLIENT <br /> E ' <br /> (Analytical Immediate <br /> 4TiA.T's::- Attention (200% sumhvge) _RUSH (so-l00% .umh"ge) Standard <br /> Cal Lab ID Number: (for lab use only) ffff - <br /> hent Netafne W41te COPY only- , (Revised I/87) <br />