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L De! arRna4cal <br /> 2 Ava Irwna CA 926%4949)261 1022 FAX 49491 261 1228 . <br /> 1014E Caale Ile A Cnllnn CA 92324 (' )37""7 FAX 1909)370 1046 <br /> 7277"enhuZ Sul a 12 Van Nuys CA 91406(818)779 1844 FAX(018)779 1843 <br /> 9830 South 51 sl SI Suite B 120 Pi"..AZ 85044 (468)78$-0043 FAX(480)785 0851 <br /> 9404 Chesapeake Dr Suite 805 San Diego CA 92123 (85a)505.9598 FAX(6 56)505 9688 <br /> CHAIN OF CUSTODY FORM <br /> Client NamelAddress Protect/PO Number Page •�of <br /> 5Analysis Required <br /> r/ L <br /> Protect Manager one Number r4Q <br /> Sampler Fax Number V} <br /> Sample Sam — � y <br /> p Sample Container #of Sampling Sampling Preservatives <br /> Description Matrix Type Cont Date Time <br /> f --1 Zv( aft ��- <br /> / ry, Special Instructions <br /> - 7 'L—e2Zl <br /> I <br /> �k <br /> 4 <br /> Relinquished By Date/Time <br /> Received by Datei"Tme Turnaround Time (Check) <br /> ef <br /> Relinquished By Date�me same day 72 hours <br /> Received by Date/Time 24 hours <br /> S days <br /> Relinquished By DateMme 48 hours normal <br /> Rece i�Lab by Date[ <br /> f Sample Integrit (Check) <br /> intact on v <br /> Note By retrnquishing samples to Det Mar Analytical client agrees to pay for the services requested on this chain of cu y form and any add)t nar analyses performed on this protect Payment ice <br /> services 1s <br /> due within 30 days from the date of invoice Sample(s)will be disposed of after 3o days <br />