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IN M M M M M = WINHOW3sts- M = <br /> Sierra laboratories,Inc CHAIN OF CUSTODY RECD <br /> 1525 Endeavor Place 714-758-9988 Date ( Page --Lof <br /> ll <br /> S[E R RA Suite D FAX 714-758-9692 <br /> -60-0-C. Anaheim,CA92801 <br /> Client: F-�J\j co r e Client Prot Name ( 25 Analyses Requested <br /> Address tfcr��Loki 6 C. Client Prol No <br /> /.jQ For Client Useoslevlll,�'-R 1 <br /> G149S Turn around requested n <br /> /,. Immediate Attention p� �✓ <br /> Client rd No 9T�[ 79W Rush 24-48 hours <br /> Rush 72-96 hours <br /> Client Prof Mgro'n K Mobile Lab <br /> Normal <br /> Client Sample No Date Time Sample Matrix Preservatives Container No of <br /> Con <br /> Liquid Solid Yes No Type gainers 1 Remarks <br /> 1 - la Z X TMAR, 2 X <br /> ap UU <br /> MW <br /> Sample Si ature Received by Date Time ` otal No of Containers <br /> The delivery of samples and the signature on this <br /> chain of custody form constitutes authorization <br /> Rel quis ed by Date Time Received by Date Time to perform the analysis specified above under <br /> Sierra s Terms and Conditions, unless otherwise <br /> �0 z�»9 — — - agreed upon in writing between Sierra and Client - <br /> Relinquishe y Date Time Received oratory by DaW Time 'notal No of f <br /> Containers Recd <br /> Special In <br /> l_', Q�LABQ YCondltton ply �recelved:� z Mkt F <br /> ` r IKo°C Illed rope` H '" orlypprlate Sample Container-- <br /> 3� ytt Y <br /> ntact 5 t PLabeied <br /> -N! Appropriate Preservatives� �Ather # <br /> t <br /> 1 <br />