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�Z ASSMA T ED LABORATORIES <br /> sob N Batavia 0 Orange CA 92868 <br /> CH IN OF CUSTODY RECORD <br /> (714) 771-6900 G FAX (714) 538 4239 (✓ C, <br /> Date .f_C� t Page of <br /> C, L <br /> CLIENT Q C, {S <br /> (ADDRESS (7�� ( i� /VQ�2 � - l�l] -0--ua PROJECT MANAGER <br /> f �r -- , Yn�2�/` �ry Samples Intact Yes No_ <br /> C �Lf6Z County Seals Intact Yes No <br /> � P I�ER Sample Ambient_ Cooled _ Frozen <br /> --- - _ <br /> PROJECT NAME SA PL ignature Same Day_ 24 Hr <br /> Regular ~4$ Hr <br /> SAMFLF TYPE NO OF SUSP <br /> SAMPLE LOCATION L�a�E cNrNR, CONT.m TESTS <br /> NUMBER DESCRIPTION W iT( R� 5IR SOLID REQUIRED <br /> �����Ta� M� Y��7 �- � � � I �Z6O Sem ��N�I�•,�f � <br /> I : eA-,OLVis <br /> f <br /> f <br /> f <br /> I <br /> I <br /> Xinquish& <br /> hed by (Si lure) Received by (Signature) �at /T e 1 hereby authorize She performance of the above <br /> r indicated work <br /> - <br /> IR b egnature) Received b aborato�y �r an sls Date/T e <br /> (Ssgnature) <br /> ISpecla€ <br /> rf Insions � Mx <br /> � DISTRIBUTION While with reper to ALH,4 �-1. A",Y ort <br /> ■..�.� «■� ■...E ,�...� s�.rt to c..�:�r ..... ...� ...� .� <br />