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ti <br /> 2852 Alton Ave 1014 E C r Suite A 16525 Sherman Way Suite C 1 1 2465 W 12th St Suite 1 <br /> el MarAnal Cal Irvine CA 92714 Colton CA 24 Van Nuys CA 91406 Tempe AZ 85281 <br /> (714)261 1022 (909)370 4667 (818}779 1844 (602)968 8272 <br /> f'.4 FAX(714)261 1228 FAX(909)370 1046 FAX(818)779 1843 FAX(602)968 1338 r .` F <br /> 6b�q�.a <br /> CHAIN OF CUSTODY/REQUEST FOR ANALYSIS <br /> Client Name/Address Project <br /> I N�E'2ntA`n�N (J -FJOILtL uc1[T�I) ("-t aj� Analysis Required <br /> Az 2-701 N W►"uN WAY'SSOC J�'rbW, CA q S 295 <br /> Project Manager Sampler o <br /> PA K M WeTHY �r�J C7 n��, � to <br /> %D C) <br /> Sample Sample Container #of Sampling a CID InstructionsSei Special <br /> Description Matrix Type Cont Datef ime Preservatives �- <br /> 'L 16 C15 <br /> 14-20 40mL 14 Q <br /> 1"1 'I S <br /> MW" 2 H-7D 11 2 j2 ov <br /> 1AW-3 H2 �� 2 <br /> Mw-y- IA-iO 2 ,� <br /> H-) 0 Z " <br /> t <br /> Relingy hed By Date/Time / eceived By DatelTime C—,1 urnaround Time (check) <br /> II rr, atry � r 11 e day 72 hours <br /> 051795 G ..t1 � f1���� 1 ,n�/?.��J, �, , <br /> JRehngwshed By Date/Time Received y Date ` e 24 hours 5 days <br /> 48 hours normal <br /> Sample Integrity (check) <br /> Relinquished By Date/Time Received in Lab By DatelTime <br /> i intact on Ice <br /> Note Samples will be disposed of after 30 days 4 <br />