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Sierra Laboratories,Inc CHAIN OF CUSTODY RECORw <br /> 1525 Endeavor Place 714-758-9988 Date j2 Z-Page / of r <br /> SIERRA Suite D FAX 714-758-9692 <br /> ...o.,Cs Anahelm,CA92801 <br /> client' t���K .�5 _ Client Prod Name Analyses Requested <br /> Address• e Chent Prod No �2� <br /> Su (L a o For Client Use <br /> Turn around requested <br /> rr JJ Immediate Attention <br /> Client Tel No j -7t 7 TC0 Rush 24-48 hours <br /> Rush 72-96 hours <br /> Chent Prod Mgr Mobile Lab <br /> Normal <br /> O <br /> Client Sample No Date Time Sample Matrix Preservatives Container No of <br /> Con Q <br /> Liquid Solid Yes No Type lainers Remarks <br /> I <br /> w_?)_ 1..� x ► c Q„/r n,.,�c� rep <br /> plc <br /> 61a�5 A <br /> 1 � <br /> 5 pier Signa a 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 /> lin ishDate Time Received by Date Time to perform the analysis specified above under <br /> O ,� Sierra s Terms and conditions, unless otherwise <br /> !// agreed upon in writing between Sierra and Client, <br /> Relinqu hed by Date Time Received at Laboratory by Date Time Total No of <br /> itN 1��1 a 1X5(7 Containers Recd —Z <br /> Special Instructions N , k� a � <br /> RAN �Q U t ' w"��� y �� B Cortditfon samples redelveci. <br /> or (�f�� - Chilled >i Y � €� ' ? " " APproprlate SampleContainer <br /> }: tact� t r ; 'Properly€atseledr, = k <br /> 4 Approprlf-E Other <br />