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I-ASIERRA LABORATORIES CHAIN OF CUSTODY RECORD <br /> TEL 714.348.9389 ale �A�°!yS-' tinge f �d { <br /> FAX 714.348.9115 U — <br /> 26052 Merit Circle•Suite 145 •Laguna Hills,CA•92653 <br /> I.ah 1'rujecl Nu � <br /> Client ��t,k Client Proj Nurnher/Proj Noine Analyses Requested o <br /> Client Address <br /> k <br /> rT <br /> e <br /> Turn <br /> u <br /> Requested m <br /> Around Time <br /> R4 ❑Imediale Allenllon <br /> Rush 24-4 hour r] <br /> Cllenl'rel No, 0 Ruch M06 houn <br /> Client Fax No <br /> 9 y <br /> Client Prof Mgr ❑Normal <br /> 4 <br /> ❑Mobile R c <br /> Stearn Container No.of <br /> Client Sample No Sa ie No DaleMirie Matrix Preservalives 7 Cuntn ere 'i 6 d <br /> C nntniculs <br /> 1rc�— P 8G Iv /o-�sr W l i 3 <br /> Mw-3P 96(k x <br /> sp <br /> JkL2- <br /> M\,(/ <br /> X <br /> riw-- I P 8 I-P Iz�<s X x <br /> L4? <br /> x <br /> F <br /> a <br /> SrmpkrSFgmtnr< shipped VI Total Nwnber of Containers Sample Disposal <br /> prinled Name <br /> (CarrkrlH'ayWtl No) Submitted to Laboratory ❑ Relurnla Llkni <br /> 0 <br /> RNf obhed 6 Data Received g +.Q The dethery dumplw and the eigasturr on Ihb ehNh•f ewlody fam mnsthutea <br /> Dole J oulhorlullonloprriormThe an•1yenspedlledab•rrupderSIERRA aTerm sad � Lab bbpoal <br /> Com an <br /> 4oedillonr,valor dhtrwbe agreed upon In willing between SIERRA aad CLIENT <br /> Time Cam n ��'�- 71mr 5110 upon <br /> a4..—.1 Archie�mud <br /> RNingvbhrd ey Date Rft i,.d By bale Total Number of Containers U other <br /> Company Time Campany Time 2? Received by Laboratory <br /> eFOR LABORATORY USE ONLY.Rampie Receipt Conditions. <br /> Itelloqukhtil sy Data Received By baleaied r� <br /> �+ U Appropriak Srmrpk Container <br /> Company7Eemt Com n Time ApproprlaltPfestrvutvtsq <br /> Special 1RSITUcIiunS �� ec <br /> u- sampksealslllhrr_Se•-�� Vo6f A b/EIf., <br /> A.,auoh U i'rvperlp#alxkd � Sampte IACalloer <br /> MDISTRIS IN W l ctOmler a slaryh Nt epy_ <br />