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�l >• M ' Mm M M M mag ` )m M <br /> Sierra Laboratories,Inc CHAIN OF USTODY R1=CD <br /> 1525 Endeavor Place 7 -758-9913$ Date Page _ of <br /> S I E R R A Suite D FAX 714-758-9692 <br /> .•o� �a� t� Anaheim,CA92801 <br /> Client: 3�tN V �� Client Prod Name Analyses Requested <br /> Address Client Proj No 7 T� ^ <br /> For Client Use <br /> Turn around requested <br /> Immediate Attention <br /> Client Tel No 72 00 Rush 24-48 hours <br /> --, Rush 72-96 hours <br /> Client Prot Mgr _ �rC,/� Mobile Lab <br /> Normal <br /> Client Sample No Date Time Sample Matrix Preservatives Container No of <br /> Con <br /> n�1 Liquid Solid Yes No Type tainers Remarks <br /> Ml1J-Z- �? �O► � ��/ r 55 <br /> 26 " <br /> 60 <br /> r <br /> M er's Sign ure Received by Date Time Q Total No of Containers <br /> The delivery of samples and the signature on this <br /> chain of custody form constitutes authorization <br /> Re qui Date Time Received by Date Time to perform the analysis specified above under <br /> Sierras Terms and Conditions, unless otherwise <br /> o I�fV 1'«,y f "j f✓ agreed upon in writing petween Sierra and Client. <br /> Relinquish by Date Time Received at Laboratory by Date Time <br /> Total No of } <br /> Containers Recd I <br /> Special instructions z/ %� <- 3 � , <br /> _ »`Candltlon samples reCelved.. <br /> �/l T Q f/2 _ Chilled r r £` „° �; ;', <br /> `� 1 Appropriate Sarnple Container� '4 <br /> �N <br /> r�'QtGc/1 !t/ x Intact a Pr pelyLabefed` *f <br /> Aopropriate Preservatives QtherL V�� _ n,, 7r <br /> x k <br /> I <br />