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ice. i♦ � � � � � fiiiii�` f♦ � i♦ � � �� <br /> Centrum Analytical Laboratories, Inc. <br /> Centrum Job# Q <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 L <br /> Analyses Rec uested <br /> Project No.: Project Name: m <br /> o Turn-around time <br /> Project Manager: L Ph e: F ` V 2 ❑ 24 Hr. RUSH' <br /> OL._ o .,: a = D 48 Hr. RUSH` <br /> Client Name: Address: /^� �� �f0 a o ❑ Normal TAT <br /> (Com fj� / rC N °N° <br /> a o a W eddibral ctw ge.eoriy <br /> Centrum Ifo Sample ID Date Time Sample Containers; y a <br /> (Lae use orgy) ( appear- <br /> Remarks/ <br /> As V ahold s Site location <br /> ppear on report) sampled sampled matrix #and type 0 c p Specie!Instructions <br /> 0 a ISO 1 n a � <br /> 72T L UDAS <br /> qA S6,011, <br /> — <br /> L iii <br /> S �. <br /> L <br /> ff_01- P <br /> --/ <br /> 7 r 1 <br /> f <br /> Ilk <br /> y <br /> Reli Sam s Signature) Da Time RoU shed by: _ Date Time J� <br /> s To be competed by laboratory personnel: Sample Disposal <br /> 1IL <br /> eived ; C66 f Time t ehmd by; ;. Date Time Samples chilled? Yes p No <br /> ❑ Client will pick up <br /> Custody seals? 3 es No <br /> Rellrqulshed by: i _ Date Time <br /> The delivery of samples and the signature on this chain of custody form All sample containers intact? Yes Q No ❑ Retum to client <br /> 4 constitutes authorizationperform the analyses specified above under R elved ���by- �f � Courier pied Ex 0 Hand carried. <br /> the Terms and Conditionss set forth on the back hereof. 1 ❑ Lab disposal fee$5 <br /> Laboratory Notes: Sample Locator No. <br /> White Copy-original(Accompanies Samples) Yellow Copy-Centrum Files Pink Copy-Client Copy <br />