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Mir = M M VM M M M M = 4r M <br /> C Del MarAnalytical 1 <br /> 2852 Alton Ave 1-ne CA 92 7;4 17141 261 1 C27 FAA(7141 261 1728 57475 <br /> 1014 E Cooley Or Se A Colton CA 97324 19091 370 4667 FAX(9091 370 1046 <br /> 16525 SAeiman Way Suite C I 1 Van Nuys CA 91406 1818)779 1844 FAX 18181 779 1843 <br /> 2465 W 12th 51 Suite 1 Tempe AZ 85781 (6021 968 8777 FAX 1602)968 1338 <br /> CHAIN OF CUSTODY FORM <br /> Client Na'me/Address Protect/PO Number Analysts Required <br /> U– oAtAJ— 1NlTEY:NAT0nJA1, (��H ilk"L STCCV-T"J <br /> 2-701 N W I LScAJ (JJy <br /> pil`401�Nt) , A-k1Z ,PJA +7oq_So i� A <br /> Protect Manager/Phone Number Sampler <br /> SoTA P o # 4 4-H bZl o <br /> Sample Sample Container #of Sampling Preservatives m <br /> Description Matrix Type Cont Datelrlme Special Instructions <br /> °t A� 2 o?-as-4 <br /> MW-Z rr tt 2 02-09 <br /> Mw-3 it 2 02-006 <br /> M W-+ <br /> MW-7 it Ik2 02-oQq- <br /> ll A W [1 It <br /> R2shed By Date!Time /- n Receive Date/Time Turnaround Time (check) <br /> Q f ( / < �G 10 y! 1� �0 same day 72 hours <br /> 1,10"Relinquished By Date/Time Received by Date/Time 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Date/Time �celved 1n Lab by Date !Time Sample Integrity (Check) <br /> intact on Ice <br /> Note Sample(s)will be disposed of after 30 days <br />