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� � � � i♦ i♦ � � � i� it � i� i� � � <br /> s <br /> Centrum Analytical Laboratories, Inc. Centrum Job # <br /> 290 TENNESSEE STREET (909)798-9336•(800)798-9336 Chain of Custody Record <br /> REDLANDS,CA 92373 FAX(909)793-1559 <br /> Page of <br /> Analyses Rec uested <br /> Project No.: — Project Name: <br /> N U Turn-around time <br /> Project anagen: Ph ne: Fax: kn v ❑ 24 Hr. RUSH" <br /> f ` ` r�! C a <br /> SNl�L� `2 ¢/i+ r 3 $ m CO <br /> ; o `E a = El 48 Hr. RUSH' <br /> Client Name: A res": 17 t 7� I f 94e"1 } 1 �f p �aV # ❑ Normal TAT <br /> (CompsEA) N M ap U Regw6s <br /> P—waw+. <br /> o M Y is U to M Watia�F throes SPAN <br /> O �+ <br /> Cerrtrurrr ill Sample 1D Date Time Sample Containers: d �u� ' µ $ Remarks/ <br /> (Lab use aim &a snored appear on re Site location <br /> paq sampled sampled matrix #and type 2g o Special Instructions <br /> g <br /> IL <br /> I <br /> Sa -i o <br /> i <br /> -s :ao <br /> IR <br /> X <br />' IDL <br /> i <br /> 83-as' l , <br /> -Rel� ah <br /> by:(Samplers Sigma Date Time Reil shed by: ate me <br /> To be competed by laboratory personnel' Sample Disposal <br /> 7r, Y y <br /> Wei W: D Ti eceNed by: j Dati Time Samples chilled? Yes ❑No <br /> Qt' Custody seals? ❑Yes No ❑ C11errt wiR pickup <br /> Relinquished by: Date Time <br /> e delivery of samples and the signature on this chain of custody form All sample containers intact? Yes ❑No ❑ Retum to client <br /> constitutes authorization to perform the analyses specified above under <br /> i the Terms and Conditions set forth on the back hereof. R slued La me Courier ❑UPSTed Ex E3 Hand carred <br /> ��j (41' <br /> ❑ Lab disposal fee$5 <br /> Laboratory Notes: W V v Sample Locator No <br /> White Copy-Original(Accompanies Samples) Yellow Copy.Cerftm Res <br /> Pink Copy-Client Copy <br />