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2852 Ai1on Ave,Irvine,CA 92606 (948)261 1022 FAX(949)261 1228 <br /> 1014 E Cooley Dr Suite ftolton,CA 92324 (909)370-4667 FAX(909)370-1046 <br /> Del Mar <br /> A ��� I 7277 sapealw rr,Suite 8012 an Nuys,CA 91408 (818)779 1844 FAX(818)779 1843 ' <br /> I v H 8484 Chesapeake Dr,Suite 805 Sen Diego CA 92123 (858)50518596 FAX(856)505-9589 i <br /> 9830 South 51 at St Sults 8-120 Phoenix AZ 85044 (480)785.0043 FAX(480)785-0851 <br /> fh° I A 2520 E Sunset Rd,Sute 3 Las Vegas'NV 89120 (702)798.3620 FAX(702)798-3621 1 <br /> CHAIN OF CUSTODY FORM Iv,- = ; Page of <br /> Client NamelAddress ' ProjecVPO Number av <br /> Analysis Required r <br /> At,c- <br /> Project Manager Phone Number Q <br /> �r c, M `1 $ o 10-1 �= N Ll V OTC— <br /> Sampler <br /> C—Samplera )} CD O <br /> M1 1 S t a Fax Number �c A <br /> Sample Sample Container Al of Sampling Sampling Preservatives C1 <br /> Description Matrix Type Cont Date Time - �� <br /> Special Instructions <br /> lyV 04 <br /> ��v N Nuc <br /> � - B lyes ' <br /> 5 ' <br /> 1530 <br /> w 2 8 Lj IN50 X <br /> MW - NC- 3 fro) 5 <br /> 3 crq1 /63S <br /> (Jl3 — <br /> P'j 0) - (- .;� ']Wit' x,a (, ►� # �! - <br /> i, <br /> Relln u he By D Mme <br /> �� ��� J- 26 <br /> �,L `�9SO Received by Date Rme Turnaround Time (Check) <br /> same day 72 hours <br /> lRefinquished By ; Date!Time Received by Date Mme 24 hours 'S days r <br /> 48 hours normal <br /> Relinquished By Date/Time Received in Lab by Date/TimeSample Integrity,-Check) <br /> 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 servloes is <br /> due within 30 days from the date of invoice Sample(s)will be disposed of after 30 days . <br />