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• 17461 Derian Ave 8100 Irvine CA 92614 (049)261 1022 49)260 3299 <br /> 1014 E Cooley Or Suite A Colton CA 92324 (909)370 4687 FAX(909)370 1046 <br /> 9830 Soulh 51st SI,Suite B 12D,Phoenix AZ 85044 (480)785 0043 FAX(480)7a5-0851 <br /> esti merica <br /> 2520E Sunset Rd 83,las Vegas,NV 89120 (702)786 3820 FAX(702)798-3628 <br /> ANALYTICAL. TESTING CORPORATION CHAIN OF CUSTODY FORM Page 3 of <br /> Client Name/Address Project/PO Number ca Analysis Required <br /> 'e/ate (re yr�a�n.+.[..16 /"/I.� (90 Z- 7,0?Pa-v- <br /> rela� k. l Sok(-, e A ' IT <br /> Aygt�JJA oo k o <br /> Protect AAan ger Phone Number o a � <br /> 13 <br /> Wo,,4-1( 6O Z 7 g a-7a-7 <br /> AS ,e. 4 � <br /> Sampler Fax Number oo `n '1. <br /> Sample Description Sample Container 0 of Sampling Sampling preservatives �� Special Instructions <br /> p Matrix Type Cont. Date Time �4- <br /> G 14za I.1 br5 jk f'30 -'v- <br /> T <br /> a a ifS;a <br /> At <br /> ( 2 <br /> 0 <br /> Relinquished yDate/T€me Recelv Date/Time Turnaround Time (Check) <br /> ZI J� .l -ZI-�; 1214 same day 72 hours <br /> Reil ulshed B Date/Time Received Date/limo 24 hours 5 days <br /> 48 hours normal <br /> Relinquished By Date/Time Received In Lab By Date/Time Sample Integrity (Check) <br /> Intact on ice <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 for services Is due within 30 days from the date of Invoice Sample(s)will be disposed of after 30 days <br />