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W z <br /> CHAIN OF CUSTODY RECORD <br /> CLIENT i'��� _ CK Yln <br /> fed <br /> NAME: T REQUEST r0 ANALYSIS <br /> Analytical LaboFOO <br /> oriea <br /> ADDRESS: 3qk6k/d � DATE: 'V30"15- 630 Maplc Ave. <br /> -ra G 113 PAGE I OF�� Torrance,Callf.90503 <br /> Te I: 310-618-8889 <br /> PHONE NO, 316 2-3 7 --FAX NO. 6 `3A Fax: 310-618-0818 <br /> PROJECT NAME: I IrCI_ 1i1 I 1 r �ietA 41 y/P �q-P —t)D1Z-f Dmf� �irLr Ch' Q/L' o] <br /> SEND REPORT TO: 0�e MCG L�1�-�'1�• �• N, S• rJc c�1Q�4 d►� Att'C1t�D- � .fr <br /> TURN AROUND TIME (� ANALYSES RRQUIRED <br /> SAMPLER NAME/SIGNATURE ORMAL ED Ila <br /> RUSH C%j-2 5qqQ <br /> `cnv a <br /> SAMPLE SAMPLING PRESER- CO AINER SAMPLE DESCRIPTION Go m U A <br /> NUMBER DATE/TIME -4& VATIVE SIZE/TYPE WATER SOIL OTHER <br /> UOd U S'r" --"-Nt rD z:di <br /> $00d use-G8 - �= 2 y!r <br /> ,,, zips <br /> z <br /> �Yo ( X' X <br /> 7 SQ—WE3T` f 1J� `+ <br /> X <br /> 1, x <br /> TJ <br /> COMMEND S: <br /> � L / 1 t1� �YZ� '� L.�1L yo c4 <br /> G <br /> 1 � �' <br /> Relinquished b le: ` by irJn are) yol� Relinquished by: (Signature) Date: Received by: (Signature) Dale: <br /> Time: Company: Time: Company: Time: Company: Time; <br /> Company: _p, �;;J <br /> the Laboratory will be charged al$101sample. <br /> Storage/Disposal of Samples: Sample will be stared at CICY tot 30 clays at no charge and at$10/anntplo/month thereafter. Disposal of sample by <br />