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7;7Chain of Cindy Record Date <br /> i7 <br /> Q 148 S Vmewood St, Escondido CA 92029•ph 760 735 3208•fax 760 735 2469 HPL Project# <br /> ® 432 N Cedros Ave , Solana Beach, CA 92075•ph 858 793 0401 •fax 858 793 0404 <br /> LABS F-1 2373 208th Street Unit F-1,Torrance, CA 90501 •ph 310 782 2929•fax 310 782 2798 outside Lab <br /> Client T_L i?/F�✓',04 Collector ��M� �'q'�a Page Of <br /> Address '?&Z-0 6az1.'5,41/�"?;1q or6 �� �a� _ Client Project# y3' �58Z 7 4�927— (O Project Manager, /Ve4n ✓��rJ <br /> MAI ,,Dof.G U, (-4. c/,?-/Z--3 Location 0�—" sf-A(14 140 rico 6P <br /> Phone 85�"5Co 1�Dto`1 Z Fax Es K I' 0 `55 Turn around time `IV,4A'� <br /> Notes k^ C $2608 Sample Receipt <br /> o h <br /> E Intact ❑Yes ❑No <br /> W ,��, Seal Intact ❑Yes ❑No ❑NIA L, <br /> � <br /> >Z Vd ;' Cold ❑Yes [-]No <br /> c <br /> � v. x `9 <br /> r a m °�' <br /> .({� iVlA(Received on Site} v I <br /> m = C N G <br /> O O N w m Q <br /> Im <br /> Sample Container 2 N N W U <br /> Sample Depth Time Date Type Type a 0 0 X o W W Field Notes <br /> Uti0 VOAX <br /> JV50 <br /> `T r1+i'l 1Z'SS <br /> Vw-( r 3a <br /> t yZ (o <br /> Z3 <br /> 44 <br /> t Reii (Signatur (company) Received by (St ature) com any) Date Time <br /> 2-1 ( 0 2- 0 t Q <br /> Rel q shed byi,( tui f company) re (company) Date Time <br /> Z I GZ 40(V <br /> Re quis a (Si nature} (company Received by (Signatur (company) pa� Z Time <br /> G <br /> Signature constitutes authorization to proceed with analysis and acceptance of condition on back Sample disposal instruction 0 Disposal @ S2 each Q Return to client Q Pickup <br /> I <br />