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fr IMP MKS aFm = = = r r = = = M i M = = = 1 <br /> 2 Ave Irvine CA926066 (949)261 1022 FAX(949)261 122B <br /> 1014 E Cooley ate A Colton CA 92324 (909)370-4667 FAX(909)370 1046 . <br /> 9484 Chesapeake Dr Suite 805 San Diego CA 92123 (856)565 8596 FAX(858)505 9689 rr <br /> 9630 South 51 sl St Suite 6 120 Phoenix AZ 85044 (480)785 0043 FAX(4801 7BS-0851 CHAIN OF CUSTODY FORM Page ` of Z <br /> 2520 E Sunset Rd U3 Las Vegas NV 89120 (702)796 3620 FAX(702)7913-3621 <br /> Client Name/Address Project/P0 Number Analysis Required <br /> Project Manager Phone Number <br /> Sampler/ F Fax Number <br /> !'1 ciL-tf Gtr i+ �{71i�7 7 a-J i G,� <br /> Sample Sample Container #of Sampling Preservatives - <br /> I Special Instructions I <br /> Description Matrix Type Cant Date/Time <br /> ! (ria -Sim fj�C7 L fer ta) 7 !"S so t-Ic1/1, E <br /> IZ-`r eZ <br /> It-V-sem <br /> M <br /> - <br /> :o� <br /> 313 <br /> rz.57'-f.r <br /> J L"J - fL <br /> 4 F3 r ram s <br /> � d2 1=CZ U'v — <br /> /14 <br /> tn� 6 C- \ !! C 1� <br /> I <br /> Relinquish—J. Date rTime ( Received by pate/Time Turnaround Time (Check) <br /> 1 1 > ` � -5-tr", 1 -bZ same day 72 hours <br /> Relinquished By Date fl ime Received by Date/Time 24 hours 5 days <br /> �✓"�• 48 hours normal <br /> I <br /> O Date/Time Received in b b r / Date[Time C� Sample integrity (Check) d�y <br /> Relinqu <br /> ish ir��Jk l / <br /> intact on ice X <br /> lNoteBy amples to Del Mar Analytical,client agrees to pay for the services res� ted f hain of cu to y form and any additionai analyses performed on this protect Payment for services is <br /> due within 30 days from the date of invoice Sample(s)will be disposed of after 30 days <br /> COC-GB <br />