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SOUTHLAND TECHNICAL SERVICES, 10 Pa of <br /> CHAIN OF CUSTODY RECORD Lab Job Number <br /> Client .-IN Analyses Requested T AT Requested <br /> G 11 Rush 8 12 24 hours <br /> Address e J (� 7 132-3 da)s Q Normal <br /> Report Attenuo Phone 11 ax +� S pled hL c Sample Condition <br /> ria CO�g �3 t7C b 2 r V ❑ Chilled ❑ Intact <br /> Project Name/No Pr[o�cct Su 1 { 1-- o v U J m 17 Sample seals <br /> o <br /> Sample Collect No ,type* o I Remarks <br /> Client Lab Matrix Sample & size of 0m rn <br /> Sample ID Sample ID Date Time Type PrLsenL container o o 1 00 x 00 <br /> rR' shed �Conipany Date 7�m�e Received b% (ompam Container t)VLs M=Metal 3 uhe <br /> L r 0 �'^7�„� A=Air Bag P=Plastic bottle <br /> she y Compan} Elate Time Ricencd by Company G=Glass bottle V=VOA -vial <br /> out an T—h Services, Inc Note Samples are-U—iscarjed 30 days after results are reportea unless other arrangements are <br /> 7801 Telegraph Road, Suite L & K Tel (323) 888-0728 made hazardous samples will be returned to client or disposed of at client's expense <br /> Montebello, CA 90640 Fax (323) 888-1509 Distribution WIIITF: with report, PINK to courier <br />