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�! aMa! <br /> 1285r.�A <br /> CA 925G6 (949)261 1022 FAX(949)261 12281014 n CA 92324 (909)3704667 FAX(909)370 1046 <br /> 9484 Chesapeake Dr Suite 805 San Diego CA 92123 (858)505-8596 FAX(858)505 9689 7 <br /> 9830 South 51st St Suite B 120 Phoenix AZ 85044 (480)785-0043 FAX(480)765-0851 CHAIN O F CUSTODY FORM Page 4 of 2- <br /> 2520 E Sunset Rd N3 Las Vegas NV 89120 (702)798 3620 FAX(702),798 3621 <br /> Client INIame Address Pro)ecl)PO Number Analysis Required <br /> Project Manager pp )) Phone Number <br /> Sampler Fax Number _ <br /> I 'a n M <br /> Sample Sample Container #of Sampling Preservatives <br /> Description Matrix Type Cont DatelTlme <br /> �^ Special Instructions <br /> Vo A 4y) , <br /> M <br /> L,4,e (i1 j I! rr i/Cl /t� y. <br /> r-s <br /> MW -7G rr x ,c <br /> rZ-V-- <br /> "t <br /> M W - /13 <br /> ►i G <br /> I <br /> � I <br /> Relinquished y t Date!Time Received by Dale/Time Turnaround Time (Check) <br /> �O —y �` same day 72 hours <br /> Relinquished By Dale/TI le /L V Received by Date ITlme 24 hours 5 days <br /> 48 hours normal <br /> Relinquished I� Date/Time 1,2,10162- <br /> f� `� Received t ab b Date!Time Sample Integrity (Check) <br /> Lr� �t I l q 12 V(2.- 2. � � intact �� on n f <br /> Note By relinquishing amples to Dei Mar nalytical client a rees to pay for the services r ues do in of Gust dy orm and any additional analyses performed on this project Payment for services Is <br /> due within 30 days from the dale of invoice Sample(s)will be disposed of after 30 days COC-GS <br />