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C7 <br />. ..... ,J •e, 4611 V,IVl LIN I IAL 39:KVDI-t3 <br />g 2100 NORTH ALAMEDA STREET <br />COMPTON, CALIFORNIA 90222 <br />(310) 8863400 • FAX (310) 763-5922 <br />lillelli: (rq Contact <br />f <br />AkA&K <br />Address: 75 (3-7 1 City: C Civ <br />Project Name: , A <br />Project Manager: (�" <br />Due Date LURegular ❑ Rush <br />Chain of Custody <br />•. • of <br />Sample Disposition: <br />0 <br />`-r vuuc. <br />Date: <br />Sampler(s) Signature: ,vim r -"4r (L! <br />Approved By: <br />Sample Description <br />ftA aA� <br />Lab <br />ID <br />Date Time <br />Collected <br />Matrix <br />No. of <br />Containers <br />- Analysis Requested <br />1 ( j' ( (awl JIV-1(7 7 <br />Slr ds <br />Sample Conditions: SealIntact ❑ Broken L) None; Temperature C) Cold; oom; Other <br />Relinquished by (Signature) Received by (Signature) <br />Relinquished by (Signature)AA <br />Received by (Signature) <br />Relinquished by (Signature) Received by (Signature) <br />Relinquished b (Signature) / <br />q Y { 9 ) eceived by (Signature) <br />WHITE COPY - Client YELOW COPY•. <br />Y - Courier BLUE COPY - File <br />Date/Time . j <br />Date/Time <br />Daterl-ime C;" <br />Date/Time C" <br />i <br />u <br />