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0 0 <br /> r Olq a, � <br /> Centrum Analytical Laboratories, inc. Centrum Job # t <br /> 290 TENNESSEE STREET (909)798 9336-(800)798-9336 Chain of Custody Record <br /> REDLANDS,CA 92373 FAX(909)793-1559 <br /> Page of� <br /> Analyses Rec uested <br /> Probed No Project Name <br /> r 0 U o Tum-around time <br /> Project Manager Phone Fax 0 24 Hr RUSH* <br /> Q�j�} ,r PS _ +� e o a , o ❑ 46 Hr RUSH" <br /> Client Name 6w rN+ QC;O+ ddress 41bb Pn,Ww IV <br /> �- a ; n Normal TAT <br /> {Company? ��CmOnrr" �.l -2017 ��tL j z g p " .e a wa�+� <br /> a el A. <br /> Centrum ID Sample ID Date Time Sample Containers a a p o 8 Remarks/ <br /> "b use orgy) (as a shoed. Ste location <br /> spear on report) sampled sampled matrix #and type go m r .0e Special Instructions <br /> ao ro v v '� ski OL <br /> Wo—MVV5 q►,-41 `l00 ���MIx <br /> qw. �►�;z ql�- 1" 3-ADML <br /> (p Rbc--M `11� 4 ``0 <br /> 4q L <br /> �9 <br /> 1.6-Mw3 91,:4% z�qq -4Dra- <br /> 9fI,b—bOPE 9/1 f-O k <br /> Reli shed by (Samplers Signature) Date Time Relinquished by Date Time <br /> / To be completed by laboratory penmxwxl Sample Disposal <br /> Received byO Date Time Recerved by Date Time Samples chilled? &4as 0 No <br /> Custody Basis? ayes b44 0 Client will pick up <br /> Relinquished by Date Time ���'// <br /> The delivery of samples and the signature on this chain of custody form All sample contalners intact? %#1. 0 No 0 Rehm to client <br /> constitutes authorization to perforin the analyses specdted above under Rec txxato <br /> the Terms and Conditions set forth on the back hereof - r 11 0 Courier "P ad Ex 0 Rand canted <br /> �J/�,/ /� � �,��1 X Loh disposal fee$S <br /> Laboratory Notes 'v Sample Locator No <br /> A - 4 <br /> White Copy Ortglrml(Accompanies Samples) Yellow Copy-Centrum Flies Pink Copy Client Copy <br />