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Centrum Analytical Laboratories, Inc. Centrum Job # <br /> 290 TENNESSEE STREET (909)798 9336•(800)798-9336 Chain of Custody Record <br /> REDLANDS,CA 92373 FAX(909)793-1559 <br /> Page�,_o� <br /> Analyses Requested <br /> Project No Project Name <br /> m v Tum-around time <br /> N L) <br /> m L e <br /> Project Manager Phone j Fax � a a <br /> C ❑ 24 Hr RUSH' <br /> CJ —J��S �j o thn o CL �' z ❑ 48 Hr RUSH" <br /> a0 o � o Normal TAT <br /> Client Name �yown o�`�,-�,/ � fes' Address GjS r �Y{nfp�-� `�Y�Y2 g p b U o �Ram <br /> (Comperry) Qom►tiv I� 1'Y 11Y `i""� x� �L �o T' 8 CO aathmw dAws apWv <br /> Centrum ID Sample ID Date Time Sample ContainersQ io V $ Remarks/ <br /> Ste location r <br /> (Lab use oNy) (Asn should appear on report) Sampled sampled matnx #and type 2 to a _9 a a Special Instructions <br /> t7 ago in opo v N a i-i <br /> Na vr�. — �—� I o A <br /> f R E�,D �-- o �p ± n o <br /> A-n SIS . <br /> I <br /> Relinrshad by (Samplers Signature) Data Time RelincMshed by Date Time <br /> to be completed by laboratory peraomel Sample Disposal <br /> Recehred My' Date Time Received by Date Time Samples chilled? W< 0 No <br /> Custody seals? ❑Yes I No D talent will pick up <br /> Relinquished by Date Time � � <br /> i <br /> The delivery of samples and the signature on this chain of custody form All sample corRelners intact? �'vea D No ❑ Return to diem <br /> constitutes authorization to perform the analyses specified above under Roc d for boreto by D Tl 6 Courier PSlFad Ex D Hand carried <br /> the Terms and Conditions set forth on the back hereoff G y Lab disposal fie$5 <br /> Laboratory Notes V U Sample Locator No <br /> White Copy Original(Accompanies Samples) <br /> Yellow Copy-Centrum Files Pink Copy Cllent Copy <br />