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= M M M M I' V M M M M M <br /> C Del arAnalytical <br /> '957 Alwn Ave Irvine CA 97714 {T l tl 761 1072 FAX 1714,761 1 228 57402 <br /> 70 v E Cosev Dr S.o A Colmn CA 92324 [9091 370 4667 FAX(9091 578 1046 <br /> 16525 Sheman Way 5w1e C I I van Huy,CA 91406 18101 779 1844 FAX 1879]T 79 1043 <br /> 7465 W 171h 51 Su,1e 7 Tempc AZ 85 <br /> I81 1607}968 8272 FAX[607,968 1358 <br /> CHAIN OF CUSTODY FORM <br /> Client Name/Address Pro)ectlPO Number <br /> cam`; f� P 0 WAnalysis Required <br /> f) HPrLkL QC1 _ <br /> STCc,L--T <br /> Protect Manager/Phone Number Sampler <br /> Pz p 1A qk TH Y �J <br /> Sample Sample Container #of Sampling Preservatives <br /> Description Matrix Type Cant DatelTime Special Instructions <br /> x <br /> I(, tj <br /> 2-5 ' (t it <br /> ]VI W b CO 35' 11 ►I rt <br /> [ill lr1(`d& L4'5' + u i t r <br /> 1\1 W G .5-5 it X <br /> C`LC-2-r tt it tI <br /> 1\4 VV 6L; L):5' II „ i tl <br /> 1\.11 I� $G t,7 ' „ ll I I l <br /> M IV � I0' <br /> M4Up u, h u ( u <br /> M w a Q ?p' tt 14 l i it <br /> M w u G,_ qrj, It 11 <br /> Reltnquisla d B e/ / <br /> Date!Time �_ /f <br /> 12 3 Received Date/Time Turnaround Time (check) <br /> L ! 0 �� 7 same day 72 hours <br /> elinquished By Date/lime Received by Date /Time 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Date(Time Received in Lab by Date !Tr a Sample Int e rity (Check) <br /> �) , l�— f intact on ice <br /> r <br /> Note Sample{s}will be disposed of after 30 days <br />