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i� <br /> E ' <br /> Centrum Analytical Laboratories Inc. <br /> Centrum Job # <br /> 290 TENNESSEE STREET' (909)798.9336 a(800)798-9336 Gain of Custody Record <br /> REDLAN DS,CA 92373 FAX(909)793-1559 <br /> Page__�_of�� <br /> Analyse Requested <br /> Prpiect No.: Project Name: <br /> FL S r Turn around time <br /> Project Manager: Phone: . Fax: 0 <br /> ) i3 ❑ 24 Hr. RUSH" I <br /> )440 7 $ m A 9 g a s ( ` E] 48 Hr. RUSH' { <br /> Client Name: ress: A y o 2 �, a o p Normal TAT <br />` (Compo ) l/ DAI 7 �O U v Ramon Pr ep—W. <br /> f Y FL *"K-d~"x apply <br /> Centrum ID Sample ID Date Time Sample Containers: o �� $ Remarks! <br /> Site location _� ; Special Instructions <br /> (Lib uaa only) (As n snald appear on nparp sampled sampled -matrix #and type n u, b <br /> $ $ :r <br /> �gds I <br /> 3 jrp <br /> 33 <br /> Ik o -a <br /> 8 3-- y <br /> .r <br /> �• Y b <br /> .{, <br />�- mf �, <br /> by:( piers Signa Date Time Relinquished by: ate me�!�.r-r__� } y Y% To be competed by lebaratory persarxrol: Sample Disposal <br /> ec b'y�` to Tlrns ,Received by: (f Date Tlme sampies chilled? <br /> Yes O No <br /> `�!7 ❑ Client will pick up <br /> 4. Custody seals? 0 Yes KNo <br /> I� Relinquished by: Dabs Tlme X <br /> The delivery of samples and the signature on this chain of custody form Ali sampie contdners intact? Yes ❑No a Return to client <br /> constitutes authorization to perform the analyses specified above under R veil mem ❑UPS/Fed Ex O Hand carried <br /> the,Terms and Conditions set forth on the back hereof. y q` C Lab disposal fee i ' <br /> Laboratory Niles: Sample Locator No. <br /> l White Copy-Orlglnai(ACtompanles Samples) Yellow Copy-Centrum Flies Pink'Copy-Client Copy <br />