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Page 12 of 13 <br />CHAIN OF CUSTODY RECORD <br />Phone: (800) 511-9300 <br />Cofl <br />DATE: 1, r PAGE OF <br />Fax: (888) 445-8786 <br />s�Project <br />a <br />V; <br />Manager: r <br />Analysis Required <br />Project Name: ! <br />'t; � } i <br />Client: <br />Address/Location: <br />j <br />f�li' � iF `� t— <br />' <br />Email: t <br />t� Ct`L/'i t (� e'Yi bi J '�� L.... �i'lr'�,. v') C. iC,��i �L'• G. <br />Sampler: <br />lab Project No.: <br />"i"- 1.—.—i„_ <br />Sample ID/Location/Description Date <br />Time <br />Matrix # Notes <br />Relinquished by: /` <br />Date: r <br />Time: <br />1. <br />La77777 <br />Courier: <br />Received by: <br />TT <br />Date: <br />Time: <br />Relinquished by: <br />Date: <br />Time: <br />Received I s <br />Date: <br />Timet: <br />)j <br />Relinquished by: -/ <br />Date: <br />Time: <br />Receive y. <br />Date: <br />Time: <br />Requested Turn Around Time: 24 hours 48 hours 72 hours <br />5 days Other:_ <br />Matrix Codes: A = Air W I Water S = Solid <br />Special Instructions to lab: <br />Global ID: <br />Authorized Signature: <br />Page 12 of 13 <br />