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MM M Mm4c M <br /> Sierra Laboratories,Inc. CHAINCUSTODY Ri_CORI <br /> 1525 e=ndeavor glace 71 -758-9988 Date: Z Page � of <br /> SIERRA Suite D FAX: 714-758-9692 <br /> * • Anaheim,CA 92801 <br /> Client: O& Client Proj.Name: Analyses Requested <br /> Address: 7 SI0 Client Proj.No.: <br /> For Client Use: QQ� <br /> Turn around requested: �!J <br /> Immediate Attention <br /> Client Tel, No.: Z Rush 24-48 hours O� <br /> Rush 72-96 hours <br /> Client Proj.Mgr.: Mobile Mobile Lab <br /> Normal v <br /> Client Sample No. Date Time Sample Matrix Preservatives Conlainer No.of <br /> Con- <br /> Liquid Solid Yes No Type tainers Remarks <br /> X <br /> 2i <br /> s -P -�- <br /> S � <br /> SQ-4-P <br /> ST <br /> -P <br /> S -7- <br /> s <br /> Sampler' S natur Received by: 01 70 6 G 7t_M Dale Time cTotal No.of Containers <br /> S ✓'r� ✓1."' (JPS The delivery of samples and the signature on this <br /> chain of custody form constitutes oulhort:ation <br /> Reii uis ed b D to T e Received y: Date Time to perform the analysis specified above under <br /> Sierra's Terms and conditions, unless otherwise <br /> 27; I" 2%�SS 1100 agreed upon in writing between Sierra and CtienL <br /> Relinquished y: 16ale Time Re eived at Laboratory by: Da/(te, Time Total No.of <br /> 7/-vi3 11100 1 Containers Recd.: `7 <br /> Sp clal lnstructlons S� P FOR.LA8O8A f�Y l}5�'ONLY Condltlon sarnples�recdveda� z + �r: <br /> CC -j-Q �� 5�-�-i S -3p ktL, ,111I1ed � ,xy �,=a ` g ��`AFProprlaW ample Container Fr <br /> 1--� C�P S��- r AntactAh x' '� 3r'£ ✓Properly Labeled 'yam ti <br /> l QQ �.r—['� • 'nn`,�i� 7 �x �, ! c,9F r '� n p - r., 3•, A '.,a i`� <br /> CC"C <br />