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r <br /> C Del-MarAnalytical <br /> 2852 AIM Ave„Irvine.CA 92714 17141 26110FA <br /> 27 X p l4]2611228 <br /> 1 14 E.Cooley Pr,.Se A.Colton,CA 92324 19091 370.466] FAX f909i 370 I Q46 - <br /> tl <br /> 16S26 Sherman Way.Suite C.I 1.Van Nur CA 91406 1818)779-1844 FAX:8101779-1843 <br /> 1465 W,121h SI..Soil,1.Tempe.AZ 65281 16021968-8272 FAX(602)968-1330 <br /> CHAIN OF CUSTODY FORM <br /> Client Name/Address: ,_Co1Z ProjecVPO Number: <br /> ( �� Analysis Required <br /> Project Manager/Phone Number: Sampler: <br /> ivr(,% <br /> ZkoR 3f- �tCP ,a r m se.oua <br /> i Q <br /> U� <br /> Sample Sample Container #of Sampling Preservatives <br /> Description Matrix Type Cont Date/Time ILL <br /> Special instructions <br /> V�F07t� V&A <br /> j <br /> i <br /> Relinqui$.,I y: Date/Time: <br /> Red i d by: Date/Time: 1 f� Turnaround Tine: (check} <br /> 1 V same da <br /> It " ished By: n Date ime: 72 hours <br /> Re lved b y <br /> s 1 ( y- ate/Time: 24 hours � ' <br /> 5 days <br /> f 48 hours normal <br /> Relinquished BY: <br /> ate Mme: Rec�ei' d in Lab by: / 7 DBfe/Time: > <br /> ' 53T Sample Integrity: (Check) <br /> e � � <br /> Note: Sampie(s)WITI be disposed of after 30 days. r ' :s ,) ;Q ' c intact on ice �?` <br />