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1 ORANGE COAST ANALYTICAL, INC. Analya Request and Lab Job No - <br /> Page of—2– . .._• <br /> �,,�, 3002 Dow, Suite 532 Chain o ustody ..Record , <br /> Tustin, CA 92680 ,x, + :z,,i`;+,• ,. <br /> (714)832-006 4, Fax(714)832-0067 <br /> REWIRED TAT' <br /> CIlSfl�MER INF6RUATWN PROW INFORM TION <br /> COMPANY 'l L' t PROJECT NAME <br /> f 1 <br /> SEND REPORT TO K� � n NUMBER - <br /> ADDRESS LOCATION f <br /> ADDRESS <br /> PHONE FAX. SAMPLED BY �v✓ L` ' <br /> >i WWAMM DATE T=: 7 GYM tW REMARKS"ECAMNS <br /> rr <br /> Total No of Samples Method of Shipment <br /> RehNursh Dateime Re ewed 8 <br /> � /TY Datefl-ime Reporting Format (check) <br /> �( <br /> I t ?L � r v 1 P) 1' �y�y 4 I?-7�-1 t i '_0 I-)tn NORMAL SD HMMD <br /> wished By Dat rme �Z � / Rete! ed Date/Time RWOCB <br /> OTHER <br /> Relinquished By Date/T Received For Lab By Date/Time Sample Integrity (check) <br /> intact on ice <br /> All samples remain the property of the cllent who is responslble for disposal A disposal fee may be imposed if client falls to pickup samples <br />