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l , LJ.0 <br /> ORANGE COAST ANALYTICAL, INC. AnaY e qnest and Page JUUYU f <br /> A& AIIL3002 Dow, Suite 532 Chain of ustody Record f `. <br /> t 11 <br /> Tustin, CA 92680 <br /> l (714) 832-0064, Fax (714) 832-0067 REWIRED TAT x ' <br /> CUSTOMER INFORMATION PROJECT INFORMATION o° <br /> CDAAPANY 1 ` f PROJECT NAME S <br /> l l♦ y <br /> SENO REPORT TO , l i NUMBER <br /> ADDRESS 7OU f? ✓ LOCATION <br /> } p ADDRESS <br /> l <br /> PHONE i L S r"� FAX SAMPLED BY <br /> ■D OF SAMPLE 9 NJU SAMPLE CDIfrAINEN REMARKSIPRECAUTIONS <br /> CDNKER <br /> I� r1Us DATE TIME MAUIX TYPE PREB <br /> k <br /> l u y <br /> z�nn rxo '� <br /> Jf <br /> VA - T u <br /> -T 1,L <br /> Total No of Samples Method of Shipment <br /> Rehnquishe�lt Date/Time Received By DatefTlme Reporting Format (check) <br /> r NORMAL S D HMMD <br /> Rellnq ed By <br /> f DatefTime2/Fy RecelvedBy Date/Time RWOCB OTHER <br /> A LC <br /> Relinquished By Daterrim Received For Lab By Date/Time Sample Integrity (check) <br /> intact on Ice <br /> All samples remain the property of the client who is responsible for disposal A disposal fee may be Imposed if client fails to pickup samples <br />