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l --A i .a iM _ _ <br /> �--• r-T �---*M(6611116 (one CHAIN-OF-CUSTODY RECORD MOL: <br /> t_ABORATORIES true Date: Page of a. <br /> 148 So. Vinewood Street, Escondido, CA 92029 (619) 735-3208 FAX(619) 7.35-2469 816 Church Strecl, San Francisco, CA 94114(415) 920-9972 FAX (415) 920-9983 <br /> �/✓Qnc� fame4t/ �G q Analysis Requested <br /> Client: ^^ nn Turnaround Re rested: <br /> SitcAddress: A <br /> Q l, jt7 )Qaacl AOnsile/24-48 hrs. � <br /> ❑ Of(sitc <br /> ❑Other , \gyp j <br /> NQ1 <br /> Project: <br /> Sampler(signature): ai`}' �p� �p� �� �N°�. <br /> Sample ID Date Time Location 44 � � �e� 'LbR, <br /> DL <br /> -dS lD/S 1 <br /> Pit s <br /> /b 2 S - <br /> d -� <br /> IX <br /> i�� <br /> _ L l _ x S <br /> /33S X S <br /> s <br /> • MHL1lllllllllllDatc: • i i Date: • • : Date: <br /> Sample Receipt 5pe - Inst ctions <br /> Signature:' Signature:' Signature` Int ct: <br /> Printed Nam c: mg Printed iYamc: — Time, Printed Namc: Time: Yes NO <br /> Company: / Company: Company: Seal Intact: <br /> 1. • Datc: Date: DYes NO CN/ <br /> a lc: <br /> Si nature:'g <br /> Signature:*g T-_ - Signature:* Cold: <br /> in Pried Name: Printed Name: <br /> Printed Tijuc: No <br /> Company: FAne- <br /> ILi&21urc <br /> Company: Company: N/A ( eceived on site) <br /> constitutes authorixatioo to prucccd with anal sis and acct 1ancc of conditions on back. <br />