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- - - 2852 Alton Ave',Jrvine,CA 92808 (M)261-1022 FAX(949)261-1228 1s <br /> 1014 E Cooley Dr,Suitekt)oftap,CA'92324` (909)370+1687 FAX(909)370-1046 r p <br /> 7277 Hayvenhurat,Suite B-12,Van Nuys,CA 91406 .(818)779-1844 FAX(818)#779-1843 <br /> 94 <br /> De! MarAnalytical _ 84 Chesapeake Dr,Suite 805 San Diego,CA 92123 (858)505-8596 FAX(858)505-9589 ,1 <br /> 9830 South 51st SL Suite$-120 Phoenix AZ,85044 (480)785-00Q FAX(480),785.0651 1 <br /> 2520E Sunset Rd"Sufte 3 Las,VaW,NV 89120 (702)798-3620 FAX(702),798-3821 <br /> CHAIN OF CUSTODY FORM ' F w1°Page A;''Of '' r <br /> Client Name/Address ProjecUPO Number Aria s Required r <br /> slcjfjj `�fiU ,rc1v11r1¢ vt[n ��oz� C)75 , <br /> 721 <br /> r � Ca a✓1 <br /> Project Managerp Phone Number N 64� ,61 <br /> z 9 C,1 b 1 � to r <br /> Sam !er _ s <br /> P Fax Number (� Q F % <br /> t <br /> Sample Sample Container #of Sampling Sampling PreservativesMOW <br /> Description Matrix Type Cont Date Time F `� Speciallnstructions <br /> Vo/� Z zoo c7i3o ' I� A n u 1 iz e <br /> S <- 0135 ,� i T <br /> Oslo >� rtkiL 9- zy-oz <br /> Al7Llo L �° 7�, Sa pis <br /> Relinquished By Da (Time Received Date Mme Y <br /> b _ Turnaround Time (Check) <br /> Gc J 4 / 1 h S <br /> �1 same day 72 hours <br /> Relinquished By Dae Mme Received by Date Mme 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Date Mme Received in Lab by Date!Time Sample Integrity- 4Check) <br /> ii Intact ' on Ice _ <br /> Note By relinquishing samples to Del Mar Analytical,client agrees to pay for the services requested on this chain of custody form and any additional analyses 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 /> i <br /> 0 i " <br />