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Ca pvironm —n a tori s,I CHAIN OF CUSTODY RECORD <br /> ❑ SoCal Laboratory NorCel Service Center <br /> E 7440 Lincoln 5 Circle,Suite H WO a/LAB USE ONLY Date 1Z//I <br /> L G14)895-5494ar ove,CA 92841-1427 C25)68 CA 945 8577 ❑ ❑ ❑ ❑ ❑ ❑ g e <br /> (925)689-9022 Pae of Z� <br /> LABORATORY CLIENT: CLIENT PROJECT NAME/NUMBER: P.O.NO.: <br /> cos nI Conia��prt�$ C47� / <br /> ADDRESS <br /> S ✓ V J lC #640 PROJECT CONTACT: SAMPLER(S):(PRINT) <br /> CITY '0/ I- <br /> a/ ¢nIfs STA ZIP Z Mg,II,r,�t- Vl <br /> TEL: E-MAIL IA" $C, L COY H L rCv0 <br /> SU- g 36-303¢ v t c�� Y tie REQUESTED ANALYSES <br /> TURNAROUND TIME W I w <br /> _ <br /> ❑SAME DAY ❑24 HR [-]48HR ❑72 HR TANDARD <br /> ❑ COELT EDF , GLOBAL ID LOG CODE c� <br /> U <br /> m <br /> SPECIAL INSTRUCTIONS: <br /> m m <br /> � n <br /> $' m <br /> O O N v m o d <br /> m u CD 0 <br /> y CDLAB <br /> Ny Z <br /> 1L mC N R1 W <br /> USE SAMPLE ID SAMPLING MATRIXOF c v 0 a a 0- O 3c m U z F2 > <br /> ONLY DATE TIME CONT. D 0. LL r- r_ t- v <br /> z N //-W X I x Y- <br /> 2-0 <br /> w X x x <br /> Relinquished by:(Signature) Race' b (Si ature/Aff" ) Date/_/ Time: <br /> A40-0/l /o: <br /> Relinq 's by: Sign re) R by:(Signature/Af lia8on) tp Time: <br /> �� �°'4'oA f�1 s 14, t <br /> eli Is by:(Signa uRecefVAfd by:(Sign e! Iiation) Date Time: <br /> Q DISTRIBUTION:White with final report,Green and Yellow to Client. - 06/01/10 Revision <br /> Please note that pages 1 and 2 of 2 of our T/Cs are printed on the reverse side of the Green and Yellow copies respectively. <br /> v <br />