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3 - <br /> C Dei MarAnalytical <br /> 2852 Agan Ave„Irvine.CA 92714 17141 2&1 1022 FAX(7141 261�1778 <br /> 1014 E,Cooley 0, S,=te A.Conon-CA 97374 {909);70-4667 FAX[909]370 WAS <br /> 16525 Sherman way,Sm1e C.11.Van Nuys.CA 91406 [8 18)719 1844 FAX 18181 779-1643 - <br /> 2465 W.17th St.,Suite 1,Tempe,AZ 85281 $07190-8777 FAX 16021 968 1576 <br /> CHAIN OF CUSTODY FORM <br /> Client Name/Address: ProjectIP0 Number: <br /> R�,,jess :::r,,Jrm4 L , p er O Analysis Required <br /> S DS gyp. Q2374 r <br /> Project Manager/Phone Number: Sampler: <br /> 909- 3Z;5- 6,116f . <br /> Sample Sample Container #of Sampling Preservatives ,, f <br /> Description Matrix Type Cont Dateffime t!J ✓ Special Instructions <br /> '9LJU%ev.40mi. f LG/9 7 ?a— <br /> :� <br /> AN <br /> t z <br /> 12, <br /> I It <br /> Relinquished "" Date/Time: Turnaround Time: (check) <br /> �� p LC]f�� Re ved by: Date ITim r <br /> Y "" -J� J - � � j J same day 72 hours <br /> ► ' l�tl ed By: Date/Time: Received by, L&Ato/Time: 24 hours 5 days <br /> 09 <br /> Relin wished B 48 hours normal <br /> } Y Date(Time: Re " ed in Lab by: ,6te /Time: <br /> 04 Sample integrity: (Check) <br /> intact on ice <br /> Note:Samples)will be disposed of after 30 days. r� <br />