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• SOUTHLAND TECIiNICAL SERVICE#C. ) 2—of <br /> CHAIN OF CUSTODY RECORD Lab Job Number t3L 5�O <br /> Client Analyses Requested T AT Requested <br /> �� r4V I � ❑ Rush 8 12 24 hours <br /> Address �y ^ 0 2-3 da}s �Normal <br /> 4-.>; � �rw� og kz t-Rn z� l W <br /> Report Attention, Phone ax Sampled by ^ Sample Condition <br /> 1rGt �a t0$ �7 7W 9�9' 175 �f x hilted Antact <br /> asw A,- E <br /> Project Name/No Project Site [W— c y t j u © sample seals <br /> e�Y 2 Larc�ln-120 actTr ac U > y <br /> Sample Collect No ,type* c o Remarks <br /> Client Lab Matrix Sample & size of co 0 00 0 <br /> Sample ID Sample ID Date Time Type Preserve container "0 o 0 ,, O�O 00 <br /> LV-0110-1 7 2 U4 IL Ice M X <br /> - /8 iz 151 >C <br /> Im 17 - p' - J � 2s�v� � Hca <br /> '] y' - l I��.v K 1 h <br /> I f � 1 � <br /> MAL7 ' 31 l 2 X25 <br /> AAW- I -- 9-2-0 t - ,Z5 14-39 `- <br /> MTea <br /> W <br /> - <br /> x <br /> [)ate 1 rine Received VComPS Container t}pes==Plasle <br /> urs c b Compan `i A=Air Bag G=Glass bottle <br /> Relinquished by <br /> Company Date Time Received by Company <br /> outhlana Tech Services, Inc ote Sarnp es are rscar a 30 ays a er resu is are reporte un ess of er arrangements are <br /> made 7801 Telegraph Road, Suite L & K FTel ax (323) 888-10728 509 Distribution irdwim C ous withes vreport, PINK oill be returned f courier t °r disposed of at client's expense <br /> Montebello, CA 90640 <br />