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Chain-of-Custody Record Date ,1 _Z� , Page r of <br /> Project Na: 3 q 1 9 B ANALYSES 7 REMARKS <br /> Sampl rs(Signatur s): <br /> Additional Comments <br /> (QAPP,QA samples,etc.) <br /> m �, 0 0 0 O d <br /> r- N v n <br /> 1v►�-- s a M N o , <br /> �o o � <br /> o <br /> o 0 0 o <br /> gg a � <br /> i L L L L O a p <br /> Date Time Sample Number0 `—' a <br /> `o a � 0. v d <br /> �° w ur w w t- w v u. a z <br /> W - 1 w X,XI <br /> Ti r�F <br /> s 7 bAY) <br /> , -- <br /> i - <br /> Turnaround time: Results to: - <br /> 0 Total No.of containers: <br /> �t`L EFFE�Son� <br /> Rel nq�ished by(signature): Dr. Reit uished by(signature): D . Rel l ishetl b (sl ure) 12i4 Method of Shipment <br /> CAL o v6p_Ao cH T` <br /> Printed Name: Printed Nam . Prin a Name: Laboratory Comments and Log NO.: <br /> Time: , j ��C Time: L�„ni ( %KAPJ-=- I <br /> I�J� . <br /> COmpan Company: Corr}gjany: �u <br /> C �-� Il� ys <br /> Res�ived by Islgnature): ate: Re V�d by(signature): ate: Received by(signature): Date. <br /> ,. <br /> �� ~4. W30 <br /> Printed Namei-:, Printed Name: Printed N c� �}� <br /> Time: Time: Time. <br /> GaomaCrix Consultands <br /> ,\ 2444 Main Street.Suite 215 <br /> Company: Company: Company: w p Fresno,California 93721-2734 <br /> !`f} [209]264-2535 <br /> (209]264-7431 FAX <br /> Distribution: White,Yellow—Laboratory Pink—Originator <br />