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M MIMI MM MM m m jqmfi-r� s M M <br /> 94r <br /> Sierra Laboratories,Inc. CHAIN O USTODY ECOR <br /> 1525 Endeavor Place 714-758-9988 Date: mage of �[ <br /> SIERRA Suite D FAX: 714-758-9692 <br /> �•■��ATa,.■■ Anaheim,CA 92801 <br /> Client: Client Proj.Name: Analyses Requested <br /> Address: S Client Pro}.No.: :7-055 <br /> For Client Use: <br /> Turn around requested: <br /> Immediate Attention <br /> CIient Tel. No.: / Rush 24-48 hours <br /> Rush 72-96 hours �1 <br /> Client Proj.Mgr.: Mobile Lab <br /> L :X Normal <br /> Client Sample No. Date Time Sample Matrix Preservatives Container No.of <br /> con. `4 <br /> Liquid Solid Yes No Type tainers Remarks r4�C r <br /> Co.«d,l/t SA"r L Fs A_6.1� <br /> fay.✓ o.✓C A�4���1 t <br /> z�s 13 <br /> Sam I r' ignatu Received by: 0110 6d -7L- SS7 Date Time Total No. of Containers <br /> .9 t4 I(Mf ✓IA tfpf The delivery o1 samples and the signature on this <br /> Chain of custody form constitutes authorization <br /> 7equ' a Z, 1Dat Ti Received by: Date Time to perform the analysis specified above under <br /> Sierra's Terms and conditions, unless otherwise <br /> Z f 53 I to agreed upon in writing between Sierra and Crient. <br /> Relinquis ed by: iDiite ',rime Rec 'ved t oratoryb : Date Time <br /> Total No.of 4 <br /> R pv Cont ainersRecd.: am <br /> [i <br /> ►: Special Instructions: �" B 74'¢Condtt samples rec`efved��� <br /> t: x hllled�t# M. "PKI Pr ate'Samplai. ontalfler <br /> InfactTt.xpraperiy Labeled <br /> ApropctalePreservatives <br /> ... p , <br /> ,K.. <br /> -- I <br />