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0arAnakwai <br /> C 2.Allon Ave Irene CA 92606(949)261 1022 FAX 19491 261 1228 <br /> 1014 E Cooley Cr Suite A Colton CA 92324 (909)370-4667 FAX(909)370-1046 <br /> 7277 Harenhurst Suite B 12 Van Nuys CA 91406 (818)779 1844 FAX(818)779 1843 <br /> 9830 South 51 s1 Sl Suite 8 120 Phoenix AZ 85044 (480)7850043 FAX(480)785-0851 /1 <br /> 9484 Chesapeake Cr Swte 805 San Dego CA 92123 (858)505-9596 FAX(8581 505 9689 h/ , <br /> CHAIN OF CUSTODY FORM L Page of Z <br /> Client Name[Address Project/PO Number <br /> Analysis Required <br /> Project Manager P e Number l <br /> Sampler e <br /> Sample Sample Container #of Sampling Sampling Preservatives <br /> Description Matrix Type Cont Date Time Special Instructions <br /> I/V — 712- 1,6 )o <br /> ✓y'dW-q -0701 7iZ 1� <br /> z 2A 4 <br /> 6761 <br /> r. l-cD-o?a1 -7- 712- <br /> ll <br /> i5 - 670/ <br /> Relinquished By �D telTime Received by Date/Time // / Turnaround Time (Check) <br /> 3� f �� � pfti. same day 72 hours <br /> Relinquished By Da eMme Received by DateRme 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Datemme Received In Lab by Date/Time Sample Integrity (Check) �j <br /> intact on ice e <br /> Note By relinquishing samples to Del MarAnalytical client agrees to pay for the services requested on this chain of custody form and any additional analyses performed on this project Payment for services 1s <br /> due within 30 days from the date of lnvolco Sample(s)will be disposed of after 30 days <br />