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DeMennvlKerdvot- Cham of Custody <br /> — — — "Recycling For Cleaner Environment- <br /> -_ _ = 2000 North Alameda Street•Compton,CA 90222 <br /> (310)537-7100 Fax:(310)635-2946 <br /> CA-0 HS ELAP Cerii[iaale 92037 <br /> Client: ] g!A - Contact: �9K <br /> r. Tel. ,� ►s S� Fax: <br /> Address: 3244 City: State: > � Zip Code: cr <br /> Project Name- Samplers) Signature, <br /> 1 41/x*Project Manager: Approved By: <br /> Due Date A'Regu{ar ❑ Rush Days Comments: <br /> Lab Date Time No. of <br /> Sample Description ID Collected Matrix Containers Analysis Requested <br /> Sample Conditions: Sea[ ❑ Intact ❑ Broken ❑ None; Temperature ❑ Cold ❑ Roam; er <br /> Relinquished by (Signature) Received by (Signature DatelTime ��.1:2!a s 1 30 err' <br /> Relinquished by (Signature) Received by (Signature) Date/Time 7-2_-1S07_6_6-- <br /> f —2_-1 S <br /> Relinquished by {Signature} Received by (Signature) Date/Time 3eA— <br /> SPECIAL INSTRUCTIONS <br /> WH[TE COPY Client PINK OP --dourier Page of <br />