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Calscience Environmental Laboratories, Inc. '- ; t P� CHAIN OF CUSTODY RECORD <br /> SoCal Laboratory NorCal Service.CenterDate <br /> . <br /> \7440 Lincoln Way 5063'Commercial Circle,Suite H: <br /> ---'�� <br /> Garden Grove,CA 92841-1427 Concord,CA 94520-8577 <br /> (714)895-5494 (925)689-9022 Page i of <br /> LABORAT RYCLIENT: CLIENT PROJECT NAME!NUMBER: P.O.NO.: <br /> ADDRESS: PROJECT CONTACT: � t VIM <br /> INS <br /> CITY STATE ZIP �} <br /> SAMPLER(S).:(PRINT) COELT LOG CODE -1OL�RR�GEIP <br /> TEL E-MAIL: <br /> t 'VI S-9'4 q P P'fi�- tENCc.C� © 0 © ❑ T ,C <br /> TURNAROUND TIME: AZ I-AT REQUESTED ANALYSES <br /> ❑SAME DAY ❑24 HR ❑48 HR ❑72 HR ❑5 DAYS ❑ 10 DAYS <br /> SPECIAL REQUIREMENTS(ADDITIONAL COSTS MAY APPLY) _ <br /> [:1 RWQCB REPORTING FORMS COELT EDF N® S(----2-QS 1 q-3 4 4 <br /> cw <br /> SPECIAL INSTRUCTIONS: m o o `� J <br /> �' o m <br /> U � N M Q O ti O 7 <br /> CD } i <br /> s U m. O Oy Q ti pv O Gv ¢ M <br /> N O � <br /> O N � L - N O M O O O t� <br /> LAW;; SAMPLING INO � X � co <br /> � U rn m cnFIELD POINT NAME y z W U U O ca d usE SAMPLE 1D (FOR COELT EDF) MATRIXa d - H O' O c > cu U Z N O lLONLY, DATE TIME H m > > W co a a R- r U > H tU <br /> - ilvly� - <br /> ! , . <br /> WW <br /> W -- 14 A I I q5' tq/ <br /> C - 13-q t-7 `V <br /> N <br /> O <br /> n <br /> Relinquished by:(Sid ature). Received by:(Signature/Affiliation) Date: Time: ,b <br /> Relinquished by:(Signature) _ Re ed b .(Sign Pure/Affiliation) Date- Time: <br /> s� �UCID <br /> Relinquished by:(Signature) R ceived by:(S' ature/Affiliation) Date: / Time: <br /> DISTRIBUTION:White with final report,Green and Yellow to Client. V V1 0 05/01/07 Revision <br /> Please note that pages 1 and 2 of 2 of our T/Cs are printed on the reverse side of the green and Yellow copies respectively. 1 <br />