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C Del InAnalytical <br /> 205 he CA 926D6(949)261 1022 FAX(9491 261 1228 <br /> 1014E 00010YOW"A Conon CA 92324(909):570-4667 9u44 FAX(909)370-1U3 <br /> 7277 NayvenMpst Stole 8 12 Van Nuys CA 41400(01R)779 16M FAX{818)779-1943 �f <br /> 9830 Sash 51st St Saru H 120 Phoma AZ 85044(480)765-0043 FAX(460)785-0851 <br /> 9404 ChesWaAe Dr Side 6n5 San Diego CA 92123(95B)505 9596 FAX(&58)505 96a9 i <br /> CHAIN OF CUSTODY FORM Page / of <br /> Client Name/Address /' Project/P0 Number <br />� �Lc.fi/J-- .�j'1.✓�rvs'L.J'1+.����-f' �d Z - 7c�/�� -�3 Analysis Required <br /> F<L".7-es W f$Z— <br /> Project Manager ) Phone Number ell 4- <br /> 6c) <br /> 6v L_72- i --0707 Q <br /> Sampler Fax Number' `V <br /> 2-V --G70e <br /> Sample Sample Container #of Sampling Sampling Preservatives ! <br /> Description Matrix Type Cont Date Time � `� Special Instructions <br /> 1'4ty - '5 - tZt; f 1ZX, G, �-/ C <br /> 1 1A <br /> 12-1 <br /> All)- ZL -1 ZP( Yz 01 c 5-5! / <br /> nil tv_ -2-b - J i-c c t z/0 q <br /> I <br /> MW-Sb -/zo( r U� =55 A:V <br /> BTW-4,C--[tet ft�oi S h7 10 <br /> RellXhedsBy ,�J Date Mme Received by Datestl� Turnaround Time (Check) <br /> ' W o:�" 3! 'Sl r� same day 72 hours <br /> Relinquished By Dale Mme Received by V Date Mme 24 hours 5 days <br /> 48 hours normal ---- <br /> Relinquished By Date Mme Rece in Lab by Date Mme Sample lnteg Check) <br /> 1 J <br /> J k--� Xv� /1-rq �iD intact on Ice <br /> Note By relinquishing samples to Det Mar Analytical,client agrees to pay for the services r^quested o th c alfa o cu y for an any ad tio�alyses performed on this project Payment for services is <br /> due within 30 days from the date of invoice Sample(s)will be disposed of after 30 days �� <br />