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_ Performance Analytical Inc. 2665 Park Center Drive,Suite D <br /> Air Quality Laboratory Simi Valley,California 93065 Chain of Custody Record <br /> A Division of Columbia Analytical Sen ices,btc. Phone (805)526-7161 Analytical Services Request <br /> ® An Employee Owned Company Fax (805)526-7270 <br /> Client / Address Phone Fax PAI Project No. <br /> �T � �"� ANALYSES <br /> 1 y3 S /4di-+)% �nP,� r 13%QJ 916 US 3300 �I.b qZ� 33�J ��® ( -500 <br /> C'A 'RS s3� Client Project No <br /> Client Project Name/Location <br /> J0163VID <br /> Contact Sampler(Signature) P O.qo. <br /> Client Sample ID Date Time Lab Sample Type of Container ID RegulaEx tedRemarks <br /> Collected Collected No. Sample (Serial#) (Seri <br /> Turnaround Time <br /> G 15106 IU 1.2- 06Z46 <br /> IU U — 0W x <br /> i <br /> Relinquished by:(Signature) Dafe Time R ei by:(Signatur ) a Time <br /> Relinquished by:(Signature) Date Time Received by:(Signature) Date Time <br /> Relinquished by:(Signature) Date Time Received by:(Signature) Date Time <br />