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W—Kj��Weck Laboratories, Inc. CHAIN OF CUSTODY RECORD <br />Analytical & Environmental Services <br />14859 East Clark Ave. Industry, CA 91745 • Tel 626-336-2139 • Fax 626-336-2634 <br />v i � <br />Page Of 1 <br />FCLIENTNAME PROJECT: ANALYSIS REpUESTED SPECIAL HANDLIrJG <br />❑ Same Day Rush <br />PHONE#:C �_� ❑ 24 Hour Rush <br />`48 - 72 Hour Rush <br />�Li FAX #: �jP` �cd / y VI""7 - 10 Business Days <br />PROJECT MANAGERSAMPLER < ❑ QA/QC Package <br />i I P.O. # 1 <br />�JvIV, ) Reporting Agency <br />�; dID# ATE TIME SMPL # OF r Method of Shipment <br />r7or lab Use Only) SAMPLED SAMPLED TYPE SAMPLE IDENTIFICATION/SITE LOCATION -- <br />_ <br />CONT. REMARKS <br />I- it <br />LI QUISHED Y1 DATE TIME RECEIVED BY DATE /TIME BILLING INFORMATION <br />I <br />INQUISHED BY DA E /TIME: ' RELIVED BY DATE/TIME SAMPLE CONDITION: SAMPLE TYPE CODE: <br />it <br />Temperature :'�'7_� AO=Aqueous GW -Ground <br />RELINQUISHED BY - Preserved ,%;N NA - Non Water <br />DATE /TIME RECEIVED BY DATE /TIME Evidence Seals Intact Y / SL _sudge5 50 Sod <br />DW = Dunking Wasle <br />Container Attacked Y water CL =oaCh <br />Preserved at Lab Y` "'.=W,,510 OT =ner <br />Water Mal— <br />RUSH TURN AROUND TIME MAY REQUIRE SURCHARGE SPECIAL REQUIREMENTS <br />TERMS AND CONDITIONS: SEE BACK OF THIS FORM <br />DISTRIBUTION: WHITE & CANARY - For Laboratory PINK For Client <br />