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r■� r rr rr5���� � r r <br /> CHAINF USTODY RECO <br /> Sierra Laboratories,Inc <br /> 1525 Endeavor Place 71 -758-9988 Date _ Page - 01 <br /> Suite D FAX 714-758-9692 <br /> SIERRA <br /> LA 6ORI TORILS Anaheim,CA 92801 <br /> ( <br /> Client: 't�1 '� � 1 �� ClientPro1 Nance Analyses Requested <br /> Address o Client Yroj No - <br /> (� For Cllent Use <br /> Turn around requested <br /> Immediate Attention <br /> Client Cel No Rush 24-48 hours <br /> Rush 72-96 hours <br /> Client Ptoj Mgr Mobile Lab <br /> Normal <br /> Client Sample No Date Time Sample Matrix Preservatives Container No of <br /> Con <br /> Liquid Solid Yes No Type tainers Remarks <br /> o �z <br /> _g <br /> 5 pie Si ture Received by Date Tlme Total No of Containers <br /> The delivery of samples and the signature on this <br /> chain of custody form constitutes authorization <br /> R q t ed by Date Time Received by Date Time to perform the analysis specified above under <br /> �Da <br /> � �+� Sierra s Terms and Conditions unless otherwise <br /> �,Ct Vjjy r agreed upon in writing between Sierra and Client. <br /> Relinquis ed by Date Time Received at Laboratory by te TimeTotal No of Q <br /> Containers Recd !! <br /> Special instructions QR LADORATUF3)[U5E 52N -----Condltlon'samptes recelved=,,{="_-Ftp <br /> } }' Chilled`' f �_ — i Approprlato Sarnp�e Container' <br /> 'ex Intact = 3 3n`" property Labeled aL `4 <br /> �� �� s < <br /> APpropriatePreset-vativest Other " Wit`= �-ryi � <br /> v <br />