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M M r = r r 11M •■• <br /> D Chain of Cusedy Record Date z� 070 ' <br /> [� 148 S Vinewoad St, Escondido, CA 92029•ph 760 735 3208•fax 760 735 2469 HPt_Protect#A W Q���)C2 -31 <br /> ® 432 N Cedros Ave , Solana Beach, CA 92075•ph 858 793 0401 •fax 858 793 0404 <br /> LABS D 2373 208th Street Unit F-1,Torrance, CA 90501 •ph 310 782 2929•fax 310 782 2798 outside Lab <br /> Client f 7-,1- Collector �"'•¢J �A•tQ u-- z page Of f <br /> Address & � ��� �� �� ZO� Client Protect# y3' Z58Z 7 a ?Z& Protect Manager /711ee- <br /> AI 12664o, 64 c>z/Z-3 Location �Z SSR fl.� `oo 5�&(P <br /> Phone 85P"5-&2—6>Co I Z Fax SS Fr -.56 - O SS Turn around time <br /> Notes 8260B J Sample Receipt <br /> o <br /> 4 U� {"L(� N a b Intact ❑Yes❑No <br /> Uo <br /> Lu <br /> a Q Seal Intact Cl Yes❑No❑NIA <br /> � � � � Cold 171 Yes❑No Y <br /> -0 mc F <br /> Ca e O [ NIA(Received on Site)a <br /> N <br /> m oO <br /> Mm <br /> It mSample Container x x NN o o° o °S x Field Notes <br /> Sample Depth Time Dale Type Type m <br /> o > <br /> W �- <br /> {►�W"I lZ�3S t z�oZ btz0 VDA X X <br /> MLJIZ. 1zrZa <br /> f"1G,W- lz i5 <br /> Mw-"] 17-'01 <br /> lnw.-I I 1 <br /> rtry v-(D 1'Za <br /> VW-1 1 3a <br /> uJ-7; JJ10 <br /> ki- 7- <br /> Reli (Signatur (company) eceived by (Si ature} n (cam any) Date Time <br /> ATG- 2- 0 2- 1010 <br /> Relinquished�by ature (company) R ceived by Sig ature) (company) Date Time <br /> 1 <br /> Relinquished by (Signature) (company) Received by (Signature) (tympany) Date Time <br /> Signature constitutes authorization to proceed with analysis and acceptance of condition on back Sample disposal instruction D Disposal @$2 00 each Q Return to client D Pickup <br />