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S unStar <br /> Laboratories, Inc. Chain of Custody Record <br /> iNnV VWW QuAurry ANALVIVAL SERVICES Nomo-rwim, <br /> 25712 Commercentre Drive, Lake Forest, CA 92630 <br /> 949-297-5020 <br /> Client: .$Rws +XOC=A"$, Date: b Page: l or 3 <br /> Address: f o 904 33Za �os��,�c f C� T�t Project Name: Ain M off SA &.x,V'JZ FA,(Cf 4- <br /> Phone: ��[ 612' D Fax: L1i 0 64�— (47-( Collector: i3z�s Client Project#: 2 6 0—Op <br /> Project Manager: &R s rJA+-- Batch#: 7 /&D EDF#: 'rJ 4or'00 Zo Wz 4- <br /> ul � N <br /> u � <br /> d• ❑ C ti m <br /> x <br /> n O N H <br /> Q Date Sample Container o o "' "' '� `o o <br /> Sample ID ampled Time Type Type � C* Co m CD m E. cc Comments/Preservative l° <br /> 5— z.3 50 ,� SAC <br /> Z -rr <br /> + _ ' <br /> e- <br /> 1 <br /> 5-W WAS`-L V o S <br /> S Ls <br /> �Z "Zts <br /> �3 T4 6 - <br /> I - 3b <br /> ►s (0+ - 4 <br /> Reli uis a y: {signature) Oat I Time Necei e by:{signature} Date 1 Time Total of containers Notes <br /> ✓� S! Chain of Custody sealstNA <br /> NA fir? <br /> R =y: Dnafure} -^� to 1 time Received by als(signature} Date 1 Time Se intact? 5 <br /> 5 ` LIPP S Received good condition/cold <br /> Relinquished by (signature) Date 1 ime Received by. ignature} Date 1 Time r <br /> L tJ� )( 3 /0.r4.] Turn around time. <br /> Sample disposal Instructions: Disposal @$2.00 each ur to client Pickup <br />