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DeMennolKerdoon <br />For A (Icu1jej- j(j,,,j,-,,,j <br />2ooe) North Alumeda S11-cet. C0111JUT011, C4 9022-2 <br />(31()) 537-7104) F(LI:: (310) 639-1254 <br />Chain of Custody <br />Date Puge of <br />Client: � 0 4, Contact: Tel: tq Fax: <br />I'%- . f <br />Address: 1 5�-Z City: State: c -A Zip Code.- 01 <br />Sampler(s) Signature: <br />iz� �Vv-, <br />Project Name: <br />Proy*ectM6nager: <br />Approved By: <br />Due Date "'Q Regular U Rush Days <br />Comments: <br />Sample Description <br />Lab <br />ID <br />.......... <br />Date Time <br />Collected <br />Lj -ta - <br />Matrix <br />'s <br />No. of <br />Containers <br />Analysis Requested <br />C- PA k <br />Ar <br />&L�t NZ <br />LIIILP U k-UILULUOnS: Seat Lj intact <br />Relinquished by (Signatitre) <br />Relinquished by (Signature) <br />Relinquished by (Signature) <br />SPECIAL INSTRUCTIONS -,, J ) / <br />Broken U None; Temperature Q Cold Q Room; Other <br />Received by (Sigriature) <br />Received by (Signature) <br />Received by (Signatu <br />TV7-fITEC0PV—CIi,Pnt <br />Date/Time Z//j <br />Date/Time <br />Date/Tim e,447 -,,Z_ <br />/V 7-3 et <br />