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J lq-q-7 -ct3 <br /> Sierra Laboratories,Inc. CHAIN O USTODY ECORD <br /> 1525 Endeavor Place 714-758-9988 Date: 71 Page of <br /> S 1 E R RA Suite D FAX: 714-758-9692 <br /> LABORAT ORIEs <br /> R"" Anaheim,CA 92801 <br /> Client: PW Jae Client Proj.Name: Analyses Requested <br /> Address: S Client Proj.No.: :�05 <br /> For Client Use: <br /> Turn around requested: <br /> Immediate Attention <br /> - -- - Rush 24-48 hours <br /> Client Tel:No:: Z � - - - - - <br /> Rush 72-96 hours <br /> Client Proj.Mgr.: Mobile Lab <br /> Normal <br /> Client Sample No. Date Time, Sample Matrix Preservatives _Container No. <br /> of- <br /> Liquid Solid Yes No Type Con- <br /> tainers Remarks ffg, lj <br /> > 640-55 <br /> X S lye Ef <br /> ►�� til �V i✓ o,,IeL <br /> ti <br /> Sam I r' ignatu : Received by: ct 10 6S-1L 3S7 Date TimeTota! No. of Containers <br /> L� �/} vPf The delivery of samples and the signature on this <br /> chain of custody form constitutes authorization <br /> Date Time to <br /> Re qu' a Dat <br /> Time Received by: perform the analysis specified above under <br /> Sierra's Terms and Conditions, unless otherwise <br /> 2� 43 <br /> 1100 agreed upon in writing between Sierra and client. <br /> Y,�000% <br /> !Relinquis ed by: Dale "Time Rec Zr)oratory b : Date Time <br /> Total No.� of S ? Ilov Containers Recd.: <br /> Special Instructions: "an� � Cantlltto; titple rectwl�e h ` ' <br /> #' Fe�t1riAS <br /> # �pproprlafeatnpl Container `` <br /> ;Intact .' r© AMM NIINI <br /> ert �abeled <br />