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� ' f` <br /> Enviro-Chem Inc. Laboratories 0 Same Day Turnaround Time �' ¢f Misc./PCB# <br /> 1214 E. Lexington Avenue, 0 24 Hors ' r <br /> 0 48 hours L ' <br /> Pomona, CA 91766 0 72 Hors LLI <br /> 1 Week(Standard) t— <br /> Tel: (909) 590-5905 Fax: (909) 590-5907 Q o <br /> Other: <br /> CA-DHS FLAP CERTIFICATE #1555 ,� LL 0 � UJ w <br /> cc O a � <br /> 1 SAMPLING z o w � COMMENTS <br /> SAMPLE ID LAB ID DATE TIME s 5 I— o A19�lysis Required <br /> IRt;rr6uf. t <br /> i l <br /> �. - f - - <br /> i <br /> Company Name: Project Contact: Sam er Si a a: <br /> `'� � rQp� E +�� Cli dG�c comoci m Oj�. ;¢;d;of V tom. :� I 1 . <br /> Address: 'p.y &OTC 32(03 Tel: Cow ��g' Project Name/ID: <br /> ea Fga►.oqc� W t4e1E NST <br /> iCity/State/Zip: C4r, -STCdME CA 9232S Fax/Email: M15. �B13Z <br /> D, G!O�t�4ze�CCAlt1G.CJ5. <br /> Relinquished by: r �s Received by. ti� D �'��a �'� Instructions for Sample Storage After Analysis <br /> Relinquished by: K Received by: Date&Time: 0 Dispose of 0 Return to Client 0 Store(30 Days) <br /> O Other: <br /> Reilnquished by: Received b Date&Time: <br /> J_ CHAIN OF CUSTODY RECORD � <br /> Date: fi r WHITE WITH SAMPLE-YELLOW TO CLIENT Pag@ of <br />