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CHF-MICAL RESEARCH LABORATORIES, INC. • ORANGE COUNTY CHAIN OF CUSTODY RECORD <br /> • VENTURA <br /> 2,325 Skyway Drive,Suite K r Sarna Maria,CA 93455 9 SANTA MARIA DatQd —__Page of <br /> (805)922-2776 • fAX: {805}922-5597 • (8W)J_AB-1CAL s 1 AKERSF TY FIELD <br /> s MOBILE LAS <br /> CLIENT FW)JEOT MANAGER <br /> ' ADDRESS � L`I <br /> ILCAUMBER APR 2 71989 <br /> +a <br /> EWROMMENTAT <br /> HEALTH <br /> PROJECT NAME SAMPLER (Signature) PERMIT 1 SERVICES <br /> W SAMPLE TYPE <br /> � DATE TIME WATER AIR SOLID s TIO.OF TES'T'S <br /> SAMPLE LOCATION GNTN RS REWIRED <br /> NUMBER DESCRIPTiON 4 Comp. Grab. <br /> I <br /> ir <br /> 4 <br /> o <br /> ' /P.YP4 40' <br /> U <br /> W1 <br /> W <br /> Received b Si nature) DateiTlme �, <br /> RelinQuishedby.,(Signature} y' � CfiLwiltstoresampleior3Qdauseinocllarge.Storageafter30 <br /> {V days is charged at$10 per rnonth per sample.Oisposal of sam- IY <br /> pie is charged at sio per sample.PFease indicale i.he disposi- <br /> Received by:(Signature) (ion of your sample. DatelTime <br /> ur. Relinquished by:(Signature) 9 <br /> � 1-C Geni retrieved by <br /> 2.Lab Uisposal by <br /> Received b Mobile Laboratory far field analysis: 3.Stora far days- by DatelTime <br /> ] Relinquished by: Signature) Y <br /> (Signature) A.Other by <br /> atelTirne I <br /> Dispatched by:iSignature} t7ateJTime Re ived for La to by: 6 I A-$ til <br /> III _ -aulhoriae the perfoananceof the above indicatedwork. <br /> Method of Shipment <br /> i <br /> I I ` <br /> N` - <br /> N� r <br /> 't, Special Instructions: j <br /> i <br /> �(L a! - CCA-leu <br /> Q " SOURCE:Adapled rrom U.S. EPA, 985 <br /> D11 71 RIBLJ HON'While wiali WOO,Yet lOw 10 C Lei,Pink tC.,Cou n e r.Gold to Sznnpl e Can trol <br />