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Del MarAnalytical <br /> C. 265 7 111-Ave.,Irvine.CA 92714 17141261-1022 FAX 17141 261.1228 <br /> 1014 E.Cooley 0,.Suae A.Calton,CA 97324 19091570-4667 FAX=9091370.1046 <br /> 16525 5heeman Way,Suite C 11,Van Nuys,CA 91406 10181779-1844 FAX 18161 779-1843 <br /> 2465 W.12th St..Suite 1.Tempe,AZ 65281 160719688272 FAX(6021 9681358 <br /> CHAIN OF CUSTODY FORM <br /> Client Name/Address: r G� Projectil Number: <br /> .�—•� 1 Analysis Required <br /> avly -F p w s 1 l GC- M4 <br /> kE� 23 4 rn�..f' 48► Q ,,1 <br /> Project Manager/Phone Number: Sampler: <br /> Sample Sample Container #of Sampling Preservatives iv <br /> Description Matrix Type Cont Date/Time Special Instructions <br /> 'vLIP'til 4oA't~ IlZ�l 7 te— <br /> v <br /> AJ <br /> t,A ` <br /> I <br /> Relinquished Date/Fime: Date/Tim <br /> /� Re �ved by: �� 'l Turnaround Time: (check) <br /> —Z 7— L( ) �, LJ 0, f s same day 72 hours <br /> I' fished By: Date/Time: Received by: Eiate/Time: 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By: Date/Time: Received in Lab by: Date/Time: Sample Integrity: (Check) <br /> intact on ice <br /> Note: Sample(s)will be disposed of after 30 days. <br />