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0 4 <br /> Centrum Analytical Laboratories, Inc. Centrum ,lob # 10 3P4 <br /> 290 TENNESSEE STREET (909)798-9336•(800)798-9336 Chain of Custody Record <br /> REDLANDS,CA 92373 FAX(909)793-1559 page 7— of <br /> Analyses Rec uested <br /> Proved No Probed Name <br /> M 4 7 E _ -0100966 Y Tum-around time <br /> Proled manna ar Phone Fax a 0 24 Hr RUSH' <br /> �•t i/�d L -�!b 5� 5 nor S ` tisy 570-5;q -7 , a = n n 48 Hr RUSH* <br /> Ghent Name Address Lf SS �o r �r�y� f y;{e ,'-00 o a <br /> Normal TAT <br /> tom} out.. Aad {— �� J l3� C 33Y`1! - � y .mom <br /> � 8a <br /> Centrum tD Sample ID Dade Time Semple Containers v, � o O Remarks! <br /> (Lob use orsp 4y a ahold.ppear on r•parq !templed sampled matrix Sita kx�tton 8 and type 2 $ Y - U Special Instructions <br /> fir(/a- 6� <br /> i <br /> Ral&rgll by (So } Time Retknquished by Date Time <br /> o 3 To be Completed <br /> lbyyllaboratory personnel Sample Disposal <br /> Received by Time Received by Date Time Samples chilled? Yes 0 No <br /> Custody seals? p Yes to 0 ��VM pick up <br /> Reft9lished by Date Time <br /> The deirvwy of samples and the signature on this chain of custody form All sample Iconnttainers intact? ea d No 0 Return to eaerd <br /> constitutes authorization to pedorm the analyses specdied above under by D T1 O Caroler '}��IpSlFed Fac O Nand aurlod <br /> the Terms and Conditions sat forth on the back hared R ��� !`Q� 1a J ` 0 Lab olaposal nee is <br /> Laboratory Notes Sample Locator No <br /> i <br /> White Copy Orlainel(AtcompaNes Samples) Yellow Copy Cantrum Files Pink Copy CUM Copy <br />