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r 101�ey Dr W Colter 32q PRO 466 9}37 <br /> +3 {e f 277 Hayvenhurst SUF10 S 12 Van Nuys CA 91406 (818)779 FAX(811 779.1843 <br /> fti ...T 9484 Chesapeake�r Suite BO5 San Clego CA 92123 (85B)50 FAX(858)505-9589 <br /> 9830 South 51st St Suite a 120 Phoernx AT 85044 (480)78 FAX(480)785 0851 <br /> 2520E Sunset Rd Suiia 3 Las Vegas NV Sgf X02)798 20 FAX{702}798 3621 <br /> CHAIN OF CUST DY FORM 4J 9e J of l <br /> Client Name/Address Pa - / T <br /> PrntectlPO Number <br /> b�CrEGl1✓''/`-AI. 't�1s. aa ,7Q✓'�' AnalysISRequired <br /> .mss <br /> ��J- {- <br /> Protect Manager /�` Phone Number v <br /> Sampler Fax Number <br /> Sample Sampling Sam lin gSampeontainer #of c�U <br /> Preseryatives , tn <br /> Description Matnx Type Cont <br /> ZDate Time V <br /> Special Instructions <br /> x <br /> a <br /> s a� 1 <br /> Al— <br /> des <br /> e� G <br /> w <br /> y[' <br /> 'elinquished By Da fT rile <br /> �I+�' l � Received by Dat ITime 7umaround Time (Check) <br /> 'ehngwshed By Date Mmer!" � � JVE� same day 72 hours <br /> Received by Date Rme 24 hours <br /> 5 days <br /> elinquished By Date Mme Rece in Lab 48 hours normal eN <br /> { V O/ata me Sample I,nteg�Y (Check) <br /> (2- f intact V on ice X 4'v <br /> lots By relinquishing ser les to Del Mar Analytical,di t agrees to pay for the services requ d o t i hairs of cus dy f and any additional analyses performed on thts protect Paymemt for services is <br /> ue within 30 days from th date of invoice Sample(s) 11 be disposed of after,30 days <br />