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Enviro-Chem, Inc. Laboratories OTusranmaeroDuanyd Time <br />1214 E. Lexington Avenue, o 24 Hou <br />Pomona, CA 91766 <br />rs <br />0 48 Hours 3 79 Hnur \ . ,......_ • MATRIX INo. OF CONTAINERS I 'TEMPERATURE Z <br />0 <br />1= < > cc L. U) <br />/ 0 13 <br />eb ts <br /><•.J T -- -, x x- -6 --) 0 o <br />.) <br />- <br />misc. <br />1 Week (Standarrin.\, Tel: (909) 590-5905 Fax: (909) 590-5907 ter. <br />CA-DHS EP CERTIFICATE #1555 <br />SAMPLE ID <br />IMM••••• <br />LAB ID SAMPLING <br />DATE TIME <br />Lu cc 0_ Analysis Required COMMENTS <br />3' '10-1o)-36 ‘i2-41 11:15 -.11L_- _c 140E 4,6 )c-- )4- i4. )e-__ ,/... x y.. <br />ii;tio 2 <br />.14o 10 <br />--- L\--o I 2-30 <br />, <br />' - <br />, <br />_ <br />Company Name. <br />En 4 (C c j6,‘Sec C <br />Project Contact: Sampler's Si ature: <br />Address: P. (9 6 ec )4. it 5 4-1 Tel: 8' 7' .6 '2. cg--3g- Project Name/I <br />City/State/Zip: 8 0 n n-e-,f- Fe,\ry T 0 g-38-7 05 Fax 5 km.e.S. e 6 nu fro Ac sess, c„,44 2_c71 -0 4-I - 2 0) 0 <br />Relinquished by: . 10 2 c) 'Nat Z- Received by:ak4V--,.. cw,,0 , Instructions for Sample Storage After Analysis: <br />Relinquished by: Received by: Date & Time: 0 Dispose of 0 Return to Client 0 Store (30 Days) <br />0 Other Relinquished by: _ Received by: Date S. Time. <br />Date: <br /> <br />CHAIN OF CUSTODY RECORD <br />WHITE WITH SAMPLE • YELLOW TO CLIENT Page of <br />