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2$52 Altors Ave 1014E Co Suite A 16525 Sherman Wa Suite C 1 1 2465 W 12th St Suite 1 W,7Dei <br /> MarRnalical wine CA 92714 Colton CA 92 24 Van Nuys CA 91406 Tempe AZ 85281{714)261 1022 (909)370 4667 (818)779 1844 (602)968 8272 ` <br /> FAX(714)261 1228 FAX(909)370 1046 FAX(818)779 1843 FAX(602)968 1338 + <br /> CHAIN OF CUSTODY/REQUEST FOR ANALYSIS <br /> f1 4� <br /> Client Namfcl�res����� r , Project u �/� -� ( ] �% . Analysis Required V <br /> ik`��'`'„` � �,� CN 0)Sz ti <br /> Project Manager Sampler r J ` <br /> Special <br /> Sample Sample Container #of Sampling Preservatives �' Instructions <br /> Description Matrix Type Cont Date/Time <br /> t�zC) 40 <br /> J 2- 21-Z iliV)S- <br /> Im <br /> 4 t 11 <br /> r <br /> /N1 <br /> KRelinquished <br /> y Date/Time Received By Datelllme Turnaround Time (check) <br /> same day 72 hours <br /> 24 hours 5 days <br /> y Date/Time Received By Date/Time <br /> 48 hours normal <br /> Sample Integrity (check) <br /> Relinquished By Date/Time Received In Lab By Date/time ° % � <br /> Intact on Ice <br /> Note Samples will be disposed of after 50 days ' <br />