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CHAIN -OF -CUSTODY RECORD <br />SAMPLED- (Signatur <br />Date Shipped Carrier <br />Phoneg ;-C' ' -70/ Airbill NO. <br />Cooler No. <br />2544 III BlvcL <br />West Saciramento, CA 95691 <br />(916) 372-1393 <br />ATTENTION: <br />Page JL of <br />SEND RESULTS TO: <br />Client Name Cd-- l <br />Company�/ A Y E <br />Address 0 + S / !-2i2 DIT (/ <br />Phone i & - Z ' U <br />Fal] i -)-j, lc.- �- <br />PROJECT NAMEPROJECT NO. '!2 OU kl 500 P.O. NO. <br />Relinquished by: ( ignature) <br />Received by: (Signature) <br />Date <br />Time <br />L <br />Relinquished by: (Signature) <br />Received by: (Signature) <br />Date <br />Time <br />Relinquished by: (Signature) <br />—.Rec;iv I (Sig lure) <br />Date <br />Time,S <br />Eby: <br />s <br />-� <br />7, <br />Relinquished from lab by: (Signature) <br />ReceiLed by: (Signature) <br />Date <br />Time <br />Sample ID Sample <br />Number Description <br />ANALYSIS REQUEST <br />Date/Time <br />Samld Analysis Requested <br />E�35_ (,�FAJ. /� , /, <br />Special Instructions/ Comments: <br />(f Fo- P0. /,,v <br />Sample Condition <br />Upon Receip <br />NOTE: UNUSED PORTIONS OF NON -AQUEOUS SAMPLES WILL BE RETURNED TO CLIENT <br />Expected <br />Analytical Immediate <br />TATs: Attention (200% surcharge) RUSH (so-10isurcharge) Standard <br />Cal Lab ID Number: (for lab use only) <br />t. <br />Client Retains White Copy Only (Revised I/ST) <br />