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Sierra Laboratories,Inc. CHAINF C STODY RECORD <br /> - 1525 Endeavor Place 714-758-9988 Date: �Page J_ Of <br /> SIERRA Suite D FAX: 714-758-9592 <br /> LA&UR..oa « Anaheim,CA92801 <br /> Client: 'RrliG vmVwolnYvl 4o�_\ Client Proj.Name: - y - L) - Analyses Requested <br /> AddtesS: A2S} jCkG\-�G Skr<reT Str. E,rj Client Proj.No.. _501b-J 4 - <br /> OC�C�IYI l�Lc Q 56rl For Client Use <br /> Turn around requested: <br /> Immediate Attention <br /> Client Tel, No.:9k rUZ'3%I Rush 24-48 hours �p <br /> �j ` Rush 72-95 hours <br /> Client Proj.Mgr.: e Y E < Mobile Lab a <br /> Normal <br /> Client Sample No. Date Time Sample Matrix Preservatives Container No.of <br /> Con- <br /> Liquid Solid Yes No Type tainers Remarks <br /> S6•-1-P 15 14 <br /> Sol ✓ SWS l ,/ ✓ All teS u�2X�,w ilhe,5s <br /> S --1 P C� 20 ' z Sol I rayl ► ✓ k �1• o- { <br /> S6' f 29 2 Sol ✓ S V/ V11 �ciun U1 �ouNt L11�1Y>fil`PhG <br /> 58- t �'e 30 , SO '� �R�ss 1 ✓ 1�1 1�1S10v1 <br /> 35` soIIS <br /> i <br /> Sampler's Signature: Received by: Date Time Total No. of Containers <br /> The delivery of samples and the signature on this <br /> chain of Custody form constitutes authorization <br /> elinquished by: Date Time Received by: Date Time to perform the analysis specified above under <br /> Sierra's Terms and Conditions, unless otherwise <br /> � <br /> f'-3—47Y J,'00 agreed upon in writing between Sierra and Client. <br /> l2� <br /> Relinquished by: Date Time Received at Laboratory by: Date Time, Total No. of <br /> i Containers Recd.: <br /> Special Instructions: - Ca ttt m f slue <br /> If., pot r Col tKs Ch#I1le <d Con a er <br /> 100,OO Uf eatszm P Irl$art �O} Q� any{ y <br /> ' APProPrlBfrreserwat <br /> TT <br />