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,■� <br /> . r r CHAIN OF CUSTODY REC <br /> Sierra Laboratories,Inc .758-9988 qq <br /> 1525 Endeavor Place Date �:_k� Page <br /> Suited FAX 714-758-9692 <br /> SIERRA uanhr—ss Anaheim,CA92801 <br /> Client. 1�711 Client Prot Name CC Analyses Requested <br /> Address Client Proj No ll <br /> Gr For Client Use <br /> Turn around requested <br /> '7 / Immediate Attention <br /> / <br /> Client Tel No �L G 00/ Rush 24-48 hours <br /> Rush 72-96 hours <br /> Client Prot Mgr Mobile Lab ^� <br /> Normal 'tT <br /> Client Sample No Date Time Sample Matrix Preservatives Container No of <br /> Con <br /> Liquid Solid Yes No Type tainerS Remarks <br /> Mw- - 10 <br /> �0 �m <br /> op, 60 <br /> AL— <br /> S pie s Signa re 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 /> R nq h d Date Time Received by Date Time to perform the analysis specified above under <br /> !� Sierras Terms and Conditions unless otherwise <br /> Q_�i e 2) M`,� 1 1 agreed upon in writing between Sierra and Client <br /> Relinquish d by Date Time Received at Laboratory by Date Time Total No of p� <br /> Containers Recd o <br /> 111, <br /> 71 <br /> �Q/ve5 L �pjyf I <br /> Special Instructions � Co>rEdltlonsarnptesrecei�eR <br /> `� n .. ". Chilled Approprlate Sample Container',- <br /> R N �Pf� 7�/u Intact < x � � Propedt #t abelecl <br /> H <br /> � x Approprlt�te Preserirathresu f 1-7— <br /> x <br /> r <br />