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D = Chain of Cuody Record7C0�91 <br /> ate z c-' <br /> - <br /> ED 148 S Vinewood St, Escondido, CA 92029•ph 760 735 3208•fax 760 735 2469 <br /> Pt_Protect# 5 e <br /> 432 N Cedros Ave , Solana Beach, CA 92075•ph 858 793 0401 •fax 858 793 04042373 208th Street Unit F-1,Torrance, CA 90501 •ph 310 782 2929•fax 310 782 2798 utside Lab <br /> _ <br /> Client rL SSoGrq i�i _ - Collector ,--- Page Of <br /> = Address qlr 44 95 Client Protect# Prosect Manager CDT r- GL vl <br /> - - 5AAJ lwrz6 7x G4 CKlZ3' Location AfZ5,UA01 <br /> = Phone rg- - Ga! Fax -�` �!— [:(a Turn around time �,�✓/�•`fr�f� <br /> Notes� (� f✓`> �/�� � 8260B Sample Receipt <br /> E J Intact Yes ❑No <br /> w c Seai In ct ❑Yes No b N!A <br /> f1] y C y <br /> M W <br /> _ Cold Yes ©No <br /> _ - � l�j7j a p y c <br /> — C m a a a) NIA(R ed on Site) ° <br /> ar o <br /> al O O T 41 IA N <br /> Container v Sample m m <br /> Sample Depth 'rime Bate Type Type °� W p o o g „ y� Field Notes <br /> w - <br /> 13,40 <br /> _ - <br /> M s-J-4, - 135 <br /> w- -- 1�f30 <br /> lqqo <br /> Relinquished bysgnature) / {company} Re i d by {Sid a ) (company) nate Tme <br /> Rel she y (Si at ) (company) R2,l h Sign (company) D '� Z Time <br /> t/Jc1A/i-c'1/1 � Q <br /> r �� t/ <br /> qurshed by'(Signature) _ 1� (company) ee rved a e} coTlmpany) Date e <br /> � 3t� <br /> 'Signature constitutes authorization to proceed wth analysis and acceptance of condition on back Sample disposal mstructron Disposal @$2 00 each [] f?efum to client Q Pickup <br />