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CAL SCH Environmental Laboratories Lab Job No Pa� i of I\\ <br /> 6814 Rosecrans Avenue, Paramount, CA 90723-3146 J� g �� <br /> Telephone (562)272-2700 Fax (562) 272-2789 <br /> Chain of Custody Record <br /> Client <br /> Phone (iU►'L Z Turn Around Time <br /> Contact �� � ��"Pe Fax <br /> - Rush <br /> Address <br /> 0 <br /> Project s Re uested <br /> Sampled By C` v `" <br /> Name/Signdture �A r&vl&A 6-1Eo )t �0 <br /> +V, /06 <br /> /06 <br /> Lab ID Number Field ID Daterime Sampled Bottle Type No Presery Matnx � �� Comments <br /> t <br /> _Q11 ,F, <br /> i <br /> 1 <br /> 0 <br /> Relinquished CI 7—_ _ Date/Time Sr Received <br /> Dispatched Date/Time <br /> Canter <br /> I hereby authorize the performance of the above indicated tests <br /> - 4Rec, .J_ .,._ Date/Time Received by lab <br /> C i ELCCR D(X- Custody seal(s) in tact upon receipt by lab? YES <br /> NO NONE <br />