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i <br /> Al sis a nest and Lab Joh No <br /> r ORANGE COAST ANALYTICAL, INC. naY 4 age of <br /> == 3002 Dow, Suite 532 Chain of Custody Record , <br /> 1 Tustin, CA 92680 - <br /> WWW (714) 832-0064, Fax (714) 832-0067 REQUIRED TAT <br /> CUMMER INFORMATION PROJECT INFORMATION o0 <br /> CDMPANY - f � ` PROJECT NAME r l <br /> SEND REPORT TO r ` NUMBER af4S <br /> ADDRESS s 1 h L�, •, n t v LOCATION <br /> ADDRESS S -tit Lam+-., tit <br /> PHONE FAX SAMPLED BY `> <br /> UWUM No OF &AMPLE SAMPLE SAMPLE CCMTAINHI PREF REfNAfl1fSIPRECAU710NS <br /> !! CDIITAIMS DATE TIME MATRII r" <br /> f;l <br /> I( <br /> w <br /> I� <br /> _ Total No of Samples Method of Shipment <br /> RelinqulsheOA DateMme Re shed By Datefrime Reporting Format (check) <br /> II <br /> NORMAL S D HMMD <br /> WOW y �Dal ime �� rz / Receiv Date/Tlme <br /> � 'i RWQCB OTHER <br /> Relf gulshed By Datefriw Received For Lab By Date/Time Sample Integrity (check) <br /> t <br /> t 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 falls to pickup samples <br />