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= r -=- r _r_ r it r r r ■r r � r a� r r r r a� r � <br /> �- - Chain of C41fiody Record Date //3/ ° <br /> [] 148 S-Vinewood St Escondido, CA 92029•ph 760 735 3208•fax 760 735 2469 HPL Pro)ect# <br /> ® 432 N Cedros Ave , Solana Beach CA 92075•ph 858 793 0401 •fax 858 793 0404 <br /> LABS 2373 208th Street Unit F-1 Torrance, CA 90501 Outside Lata <br /> - 0 r •ph 310 782 2929•fax 310 782 2798 <br /> Client s✓Q6 Collector 44'''VePage / Of <br /> Address (QZQ ��(�f LJ,d(4Kf 1l� �c2�7 y� <br /> ._.._ _f.T � _.......,._...._. Client Protect# y� 2'S�Z.7 ODL 5 Project Manager <br /> AJ ,1C Cock C 2rZ3 Location <br /> Phone =Stro`T� ©Ce c'Z F'ax 0 S 'S�" 4 <br /> �� ��� Turn around time <br /> Notes 20 8260B Sample Receipt <br /> � n <br /> r—+'tE N intact ❑Yes C No <br /> CD <br /> Seat Intact ❑Yes C1 No❑N/A <br /> p a Cold ❑Yes C No <br /> mQ <br /> ul o <br /> N C m a ,i �, J NIA(Received on Site) $ <br /> T Q1 a .�- N ui C O P <br /> Sample Container z m Q <br /> Sample Depth Time Date Type Type 0- W m o o W ti W Field Notes F <br /> ZB I/,,/.Z- do <br /> V)"q 5 K (p <br /> 11 .30 <br /> rjc✓ � fz`s,3 <br /> Ra6ngui❑na y S�gnat e) // - (company) Ra d by (Signat� (complan } Date Time <br /> —_ fteh q ah by (Sign re) m any) Rec i nature <br /> (company) Dal T=me <br /> — Relinquta ed y is gnaturto — (company Received by (Signature) (company) Date Ti/m1e <br /> Srgnaiure consututay autrc ization to proceed with analysis and acceptance or condition on back Sample disposal instruction Disposal $2 00 each <br /> - � -- � A @ Q Return to cLent Q Pickup <br />