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i . 17461 Denan Ave,ii9 lne CA�9261S4 (94g9)261?1022,1049)260 3297 <br /> S 1014 E Cooley or Suite A Colton CA 92324 (909)370 4667 FAX(909)370 1046 <br /> ������ 9830 Soulh 51sl Sl Suile B 120 Phoenix A2 85044 (ABO)785 0043 FAX(A80)785 0851 <br /> Testi; <br /> 2520 E Sunset Rd N3 las Vegas,NV 89120 (702)798 3620 FAX(702)798 3621 <br /> ANALYTICAL TESTING CORPORATION CHAIN OF CUSTODY FORM Page_ of <br /> Client Name/Address Pro)ectlP0 Number Analysis Required <br /> 0d1,cJ f4r,ranrrlr. )191 /0A' yK^�7 c DGZ• 7�`i'so -6G n_h <br /> rya3 .�• f "fiveu'�►G,.l Shci �� {� I ox u <br /> We 4x A Z ors <br /> Project Mana er Phone Number {� <br /> Y++C Oa k <br /> Samp r Fax Number <br /> ' 2S' 070$ <br /> Sample Description Sample Container #I of Sampling Sampling Preservatives �( <br /> Matrix Type Cunt Dale Time Special Instructions <br /> i <br /> t A,.L.- <br /> PzVb Z I&W57 <br /> �✓ -? L 13:s6 f <br /> :S I`5 <br /> L o fKr! t� J <br /> tv - to -� tai <br /> Aw- l 1 6 (6 10 <br /> IV Lf - 11C zv 1 <br /> 2 <br /> Relinquished By q Date/Time Recei y Date/Time Turnaround Time (Check) <br /> rG �w same day 72 hours <br /> R ufshed I DatelTime eceived Date/Time 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Date/Time Received in Lab By DatelTime Sampie Integrity (Check) <br /> intact on ice <br /> Mote.By relinquishing samples to TestAmenca,client agrees to pay for the services requested on this chain of custody form and any additional analyses performed on this pro)ect <br /> Payment for services Is due within 30 days from the date of invoice Sample(s)will be disposed of after 30 days <br />