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i • 17961 Cenan Ave00,Irvt e A t12614�(926 2 �A9}260 3289 <br /> S 1014 E Cooley Dr Suite A Colton CA 92324 (909)370 4687 FAX(909)370 1046 <br /> estl erica 8830 South51st St,Suite B 121),Phoenix,AZ 85044 (480)785 0043 FAX(480)785 0851 <br /> 2520E Sunset Fid S'3 Las Vegas NV 89120 (702)796 3820 FAX(702)738 3828 <br /> ANALYTICAL.TESTING CORPORATION CHAIN OF CUSTODY FORM Page of <br /> Client Name/Address Protecl/P0 Number Analysis Required <br /> IY33 <br /> ti U 3 <br /> Project Manager Phone Number <br /> � o N <br /> 0-707 a Nr <br /> Sam ler Fax Number 6% <br /> oT 7zp j27by <br /> Sample Descn tion Sample Container #of Sampling Sampling <br /> p p Matrix Type Cont Date Time Preservatives W �� j- Special Instructions <br /> 'a. <br /> .v..r. <br /> c �0 <br /> z t u t <br /> °9 r <br /> I Aw e, L, <br /> l <br /> All f-" <br /> 01i <br /> I pJ 14 <br /> Ahl 1' 61,LJa o- <br /> l <br /> /Uo <br /> 9 c L .Z b <br /> Relm uished y Date/Time Receive Date/Time Turnaround Time (Check) <br /> / I G . v - 1=DG �Z/Q same day 72 hours <br /> Ref1hqujsh�ed,2Sr DatelTime calved ate/Time 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Date/Time Received In Lab By Date/Tlmo Sample Integrity (Check) <br /> Intact on lee <br /> Note By relinquishing samples to Test America,client agrees to pay for the services requested on this chain of custody form and any additional analyses performed on this project <br /> Payment Sot•sluices is due within 30 days from the dale of invoice Sample(s)will be disposed of after 30 days <br />