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SIP- <br /> Sierra Laboratories,Inc. CHAIN#STODY RECORD <br /> 1525 Endeavor Place 714-758-9988 Date: Page —1 of <br /> SIERRA Suitefl FAX: 714-758-9692 <br /> L-RwiORics Anaheim,CA 92801 <br /> Client: RxK F,W, Lgt— Client Proj.Name: Analyses Requested <br /> Address 510 L Client Proj.No.: <br /> kkowi I I e For Client Use: <br /> Turn around requested: <br /> Immediate Attention <br /> Client Tel.No.:. 2 -- - TRush 24-48 hours_ - <br /> -= - - - <br /> Rush 72-96 hours <br /> Client Proj.Mgr.: (nE�>— Mobile Lab <br /> Normal <br /> Cfient Sample No. Date Time Sample Matrix Preservatives Container No.of <br /> 'Con- <br /> Liquid Solid Yes No Type tainers Remarks <br /> C � ~ <br /> r <br /> c <br /> Sampler' S natur Received by: 0 70 6 7z.3.-7 Date Time Total No. of Containers <br /> The delivery of samples and the signature on this <br /> Reli uIS ed b chain of custody form constitutes authorization <br /> - D to T' a Received y: . Date• Time to perform the analysis specified above'under <br /> ■ Sierra's Terms and Conditions, unless otherwise <br /> d",l100 agreed upon in writing between Sierra and Client <br /> Relinquished y: ate Time Received at Laboratory by: Date Time <br /> Total No.of <br /> 1100 Containers Recd.: <br /> Sp clai instructions . LQ� ..- ortdttla sarnpl�s r ceivec' %s * a ' <br /> eC -P Ro , sP -P s !� ,r� l ll llQtt '' 3 <br /> c 'ea ��S ApProprl�e Sampl�Contal er <br /> esP -P _ ` Appy ria exytativres »� User <br /> """"'� tib. :�' .::.� ,� <br />