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Will L Weck Laboratories, Inc. <br />Analytical & Environmental Services <br />14859 East Clark Ave. • Industry, CA 91745 • Tel 818-336-2139 • Fax 818-336-2634 <br />CHAIN OF CUSTODY RECORD - <br />Paae Of_ ---L <br />CLIENT NAME: PROJECT: <br />/ p� /1 <br />l G / l� ✓v L !� r <br />ANALYSIS <br />REQUESTED <br />SPECIAL HANDLING <br />El Same Day Rush <br />El24 Hour Rush <br />0 48 - 72 Hour Rush <br />l 7 - 10 Business Dsys <br />Elf QA/QC Package <br />Reporting Agency <br />Method of Shipment <br />1G <br />{� <br />�I <br />� <br />`� <br />_ <br />V <br />L <br />'� <br />� <br />ADD ESS: � � n <br />_ <br />PHONE #: 2- <br />FAX #: <br />PROJECT MANAGER SAMPLER P.O. # <br />ID# <br />(For lab Use Only) <br />DATE <br />SAMPLED <br />TIME <br />SAMPLED <br />SMP/Lv <br />TYPE <br />SAMPLE IDENTIFICATION/SITE LOCATION <br />CONT. <br />REMARKS <br />a .��5 <br />T -N �,� <br />.� <br />x <br />�,o6-1 z1 v <br />Lt <br />RF,L-ffUISHED B <br />DATE / E ap/4 <br />RECEIVED B <br />DATE /TIME <br />BILLING INFORMATION <br />R QUISHE B <br />DATE /TIME <br />f <br />-/_ <br />REC ED BY <br />DATE /TME <br />SAMPLE CONDITION: <br />Temperature Gs� <br />Preserved Y /C <br />Evidence Seals Intact Y / <br />Container Attacked Y <br />Preserved at Lab Y N <br />SAMPLE TYPE CODE: <br />AO = Aqueous GW = GrooM <br />NA =Non Water <br />Aqueous So = Sod <br />SL =Sludge Sw = Solid <br />DW=Drinking waste <br />Wale'oL = oil <br />"""=Waste OT = Other <br />Water Matnx <br />RELINQUISHED BY <br />DATE /TIME <br />RECEIVED BY <br />DATE /TIME <br />RUSH TURN AROUND TIME MAY REQUIRE SURCHARGE <br />TERMS AND CONDITIONS: SEE BACK OFTHIS FORM <br />SPECIAL REQUIREMENTS \ ' � t <br />U.��t\1n.2/ yr�CX�I,C r� i.../ 1`t''— <br />I 6—,jt(�� <br />DISTRIBUTION: WHITE & CANARY - For Laboratory PINK For Client _�.��, <br />I i I - 4 <br />J <br />