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DeMenno/KerdoonChain of Custody <br /> 'Reryrliny Fw-A Cleunrr tarrirw inew- <br /> 200o North Alameda Street•Compton,CA 90222 ) <br /> (310)537-71 OU Fox:(310)639-1254 Date !� ` �� 11 Page t o„f�_, <br /> Cit-1)tIS 1ilA!'0--rtiflExide#20:37 <br /> Client: Contact: Tel: Fax: <br /> Address: City: State: Zip Code: 9 g CIG <br /> 0 DoE-�dt �`� �Q v�� C_ <br /> Project Name: Sampler(s) Signature: <br /> ---- — <br /> Project Manager: °y�.J Approved By: <br /> .Due Date <br /> Regular L) Rush i_. Days Comments: <br /> Lab Date Time No. of <br /> Sumple Description ID Collected Matrix Containers Analysis Requested <br /> `.�-t� � /t jx-t f2 �2�s S�+tF Ik �i S piCs.� vvlair..—� rr—. <br /> Sample Conditions: Seale tact Broken None; Temperature L) Cold U Room; Other <br /> 01 <br /> Relinquished by (Signature) Received by (S'ignatiere) Date1 me 10 I Z; <br /> _ <br /> Relinquished by (Sicgnattire) Received b (Signature) Time 1' 1 <br /> Relinquished by (Signature) Received by (Signature) ate/71me <br /> SP�;CIAI,INSTR�T�G��'hC}l4 I <br /> l , r <br /> IIT>v COPY Client PINK COPY-- Courier <br />