Laserfiche WebLink
Performance Analytical Inc. 20954 Osborne Street <br /> Y Canoga Park,California 91304 Chain of Custody Record <br /> Environmental Testing and Consulting Phone 8187t19-1139 <br /> rax 818 709-2915 Analytical Services Request <br /> Client/Protect Name Address/Phone PAI Protect No <br /> A-9t,0 Zr 30 K'i` C rHIVSTE ANALYSES (�y{�cYyr ?a5�bsa <br /> Ptosed Lo=tion Client Protect No <br /> 7906 No,Grrl EL DOI?—"v572EeT 0*0 .9- r!0 o�} <br /> 5 To 4421.4 C ZI, <br /> Contact Sampler(Signature) PO No m U <br /> ( (O 4) l Kota Tim KO <br /> Sample Lab Type ,� Expected <br /> Identification No Date Time Sample No of Sample V Turnaround Remarks <br /> Time <br /> sYSTEM - , F�VeWT $11D f qS- 3 DOWN 0179 Pr I IL `N zH 4,e (-7y gi5owt9a <br /> SYSTEm— F.FF[.V"T 3 ZaPm 0039 1/-f� 39 95V iool <br /> i- <br /> Relinquished by (Signature) Date Timenature) Date Tlme <br /> L r— � 1 t CI� r) <br /> Relinquished by (Signature)I Date Time Received by(Signature) Date Time <br /> 'f <br /> Relinquished by (Signature) Date Time Received by-(Signature) Date Time <br /> Disposal Method <br /> White Copy Accompanies Samples <br /> Disposed br(Signature) Date Time <br /> Yellow Copy Sampler <br />