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! ! ! ! ! ! ! ! ! ! ! ! i ! ! ! <br /> • SOUTIILAND TECHNICAL SERVICEWC. + -L—of <br /> CHAIN OF CUSTODY RECORD Lab .lob Number 5L <br /> Client Analyses Requested T AT Requested <br /> .� <br /> 11 Rush 8 12 24 hours <br /> 4- ^ ❑ 2-3 days ANormal <br /> Address <br /> Report Attention, Phone rax Sampled bym o Sample Condition <br /> �Cl�fCt� <br /> 7&0 ;?(,F,957 7k Jr-7' f3E1 'SAM w V Chilled Intact <br /> Project Name/No Project Site o V) V rn © Sample seals <br /> 0 O N <br /> Sample Collect No ,type* ? C Remarks <br /> Client Lab Matrix Sample & size of 0 o 0 o <br /> Sample ID Sample ID Date Time Type Preserve container 0' o-0 I 00 00 <br /> /,z7 c4 /0-30 S,,t C ".1 t� X <br /> 6U <br /> - P;; -- lU` - z ! 2704 l6 127— " +c--{ I M <br /> 1 Cj i 1.7-1 44 105-1 -Se j c 4 i AA J( —SC�d <br /> S _ Z01 - 1,7_704 /11� <br /> -22 i — P2 7- 113' X () <br /> 17 c4 12ZX:) <br /> — 11 1.29 64 Qi'* X �C <br /> ill- its f�7 i <br /> p- 1.,Z4 01, 6�;-)1 <br /> } , e0 � <br /> ,Ib- 'C <br /> A10 <br /> -2jDi ()'l2j`5 JS <br /> LlRilmquis3hedbW <br /> Com any Date —T Ime Rec t d C ompam Container t�pes M=Metal l ube <br /> `� 11=Air Bag P=Plastic bottle <br /> Com an Date Time ceived by Company G=Glass bottle V=VOA vial <br /> p y ervices, Inc <br /> Note Samp es are tscar e 30-days a er—results are reporte un ess other arrangements are <br /> 7801 Telegraph Road, Suite L & K `lel (323) 898-0728 made Hazardous samples will be returned to client or disposed of at client's expense <br /> Montebello, CA 90640 fax (323) 888-1509 Distribution WHITE with report PINK to courier <br />