Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
0 0 <br /> Centrum Analytical Laboratories, Inc. Centrum Job # <br /> 290 TENNESSEE STREET (909)799-9336 a(800)798-9336 Chain of Custody Record } <br /> REDLANDS,CA 92373 FAX(909)793 1559 page ` of 2 <br /> Analyses Rec uested <br /> Project No Protect Name <br /> 7 GZ SElzuc /0d q 6 6 m o Tum-around time <br /> Project M gern 11 �y�,y� Phone Fax C ! y U ❑ 24 Hr RUSH` <br /> RNv !L LA4 t b q94 S 7o"-5Fry J 7o—✓"1 7L/ �i id ix [Il ❑ 48 Hr RUSH* <br /> (Company)Client me Address CSS F4ti.-Ytl.�� r1 r'.ntr f�;rti rJo g a Normal TAT <br /> r�rown , goof af Does ,a Id �4�h -L 33Y4F 'a g •oow <br /> Centrum ID Sample ID Date rime Sample Containers a a ° Remarks/ <br /> (Lar,Lae oriyy (As it shoed appear en raporq sampled sampled metnx Site location S and type 2 n .a Special Instructions <br /> e <br /> tCC2 tel( 101,141112 6 S4-rtw-01VO 66 -Vali <br /> 0146 -vi) <br /> i I Rbb b14.4b 103 CW <br /> 5 Wb '%� Is O ILA Gel <br /> W-7 14W s 6-( 1 <br /> iu— <br /> T <br /> PAIA3106 0156 16 51 64 <br /> o �b c ua �n� Crul <br /> Rean"shed W (Sam s SI furs) Date Time Relinquished by Dote Time <br /> :%/ l� 0 .�� To be compietad by laboratory pwsomel Sample Disposal <br /> Received by 17 E*tef Time Received by Date Time Samples chlped7'�Yes ❑No <br /> Custody seals? <br /> (rr O Yes 173 Q CYant Ply up <br /> Relinquished by Date Time �// <br /> The delivery of samples and the signature on this chain of custody form Au sample containers Intact? Yas O No O Retun to eland <br /> constitutes authorization to perform the analyses specified above under Rec LsDan <br /> the Terms and Conditions set forth on the back hereofory by Da Time Q Coiner X-WWd Ex D Hartel carried� D Lab depose!flee ZS <br /> Laboratory Notes Sample <br /> /Locator No <br /> V� <br /> I <br /> White Copy Original(Accompanies Samples) Yellow Copy Centrum Files Pink Copy Client Copy <br />