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M M M M = M M =Z M02 = 4r M <br /> C Del MarAnalytical <br /> 1852 Aiton Are 1-ne CA 92714 17141 261 1022 FAX[7141 261 1228 57406 <br /> ID14r Camel Pr 5uueA Coho,CA 973)4 190913704667 FAX[9091370 1046 <br /> 16575 Sherman Way 5uttu C I I Van Nuys CA 91406 JO TO)779 1844 FAX 1818)179 1843 <br /> 7465 W 12th 51 Su,te I Tempe AZ 85281 [6021 968 87 72 fAX 1607]968 1338 <br /> CHAIN OF CUSTODY FORM <br /> Client Name/Address ProjecVPO Number <br /> V—F' ry 70-5Q s,�A P Ol0 <br /> , Analysis Required <br /> V i i N. td I LLW L4/AJ Q '61�J D ZIY1 <br /> sT6(-V--rw, <br /> Project Manager/Phone Number Sampler <br /> M D. MLk", D'M I s-Mr-A <br /> -Su9 ENVLWI�Mk-n1tAL. <br /> Sample Sample 1 Container #of Sampling Preservatives <br /> Description Matnx Type Cant Date/Time Special Instructions <br /> 5o' %L, I to 1 t Ci:5 <br /> Relinqu hed By Date/Time r Received Date /Time Turnaround Time (check) <br /> l01� ? �' /�'1 same day 72 flours <br /> Relinquished By Date/Time Received by Date/Time 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Date Trime Recei d i yti Date /Time Samplq Integrity {Check) <br /> Z- � 1 tact x on 1ce�_ <br /> Note Sample(s)will be disposed of after 30 days <br />