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Lab Job No <br /> ORANGE COAST ANALYTICAL, INC. Analyequest and Page of lie- <br /> A& An <br /> 3002 Dow, Suite 532 Chain of Custody Record <br /> Tustin, CA 92680 F <br /> (714) 832-0064, Fax (714) 832-0067 REQUIRED TAT <br /> CUSTOMER INFORMATION PROJECT INFDRMATIONI <br /> COMPANY © [� PROJECT NAME <br /> SEND REPORT TO �"! jt`�QCC �os� NUMBER C-3 <br /> �J(J <br /> ADDRESS O �IevO LOCATION 2�1 <br /> O <br /> p <br /> I-1� t_j fy �pfj �0 nC (� ADDRESS <br /> PHONE u v Q FAX SAMPLED �"��E �� P. S.6FR1G'9� �A <br /> SAMPLE 10 ND OF SAMPLE SAMPLE SAMPLE COWTAINEl1 PRES l REMARKSIPRECAUTIONS <br /> CONTAINERS DATE TIME MATRIX f TYPE <br /> , <br /> ie�l P /b cA-�- r 1 oy,:71 T o o wmik V x <br /> r 4- r r u. <br /> At x294 14 , af w - V <br /> i <br /> C--FFL-UESi �� I�.o? qct 0. 40 k' ITO <br /> �Al7"C—P/V/ 10'. E y x X 010 u 1l ;OfV A-V E <br /> IV�GG��N T 4-- 64.67,q4 lo -)-f- 24-'E C44 $l, <br /> 00& a cy S <br /> I <br /> � e, <br /> Total No of Samples Method of Shipment 7- t i-cw <br /> Relinquished By Date/Time Received By Date/Time Reporting Format (check) <br /> NORMAL S D HMMD <br /> Relinquished By Date/Time Received By DatelTime <br /> RWQCB OTHER <br /> Relinquished By Date/Time Received For Lab By Date/Time Sample Integrity (check) <br /> intact on ice <br /> i I <br /> All samples remain the property of the client who is responsible ford posal A disposal fee may be imposed if client fails to pickup samples <br />