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r [ r r -OFr_- L.!-�->F�� —7011., �,r.. _C. c r c r t r ��.i"II" <br /> n n 7 <br /> EL LIU CHAIN OF CUSTODY RECORD <br /> CUSTOMER INFORMATION PROJECT INFORMATION <br /> COMPANY: G)TPROJECT NA f/NUMBEFI: <br /> co <br /> SEND REPORT r0 13ILLIN6 INFORMATION "' <br /> ADDRESS J ( BILL TO: <br /> ADDRESS v <br /> 1 9'4/SS3 J LAB JOB NO. <br /> LU <br /> PHONE: 2J 370 �, PHONE', � �t <br /> J / ,J (J � V <br /> FAX: t) /� n FAX: PC N0.', z <br /> SAMPLE NO. SAMPLE'DESCRIPTION SAMPLE SAMPLE SAMPLE CpNTAINER: RV. <br /> DATE TIME MATRIX PESERREMARKS / PRECAuTIONS <br /> 26 ;k ! SbeP✓ lj;)Nr I > <br /> S' /9.'52, b/oa- 1 x <br /> Q <br /> SAMPLER: SHIPMENT MEOD',THAIR$ILL NO.: <br /> REOUIREO TURNAROUND:* i SAME DAY 24 HOURS L 48 HOURS i. 72 HOURS _ 5 DAYS J 10 DAYS ;/ROUTINE OTHER <br /> C3 <br /> S.RELINQUISHED Y.'4 DATE 2.RELINCUISHEO SY. DATE 3.RELINQUISHED BY: DATE <br /> SIGNATURE: lGs SIGNATURE: SIGNATURE', <br /> Ic <br /> PRINTED NAM PA TIME PRINTED NAME/CC ANY: TIME PRINTED NAMEICOMPANY, TIME <br /> oC4 7z <br /> zcr <br /> i.RECEIVED BY: r' DATE 2.RECEIVED - - DAT 3.RECEIVED BY' DATE <br /> SIGNAT ,��� SIGNATU <br /> � � SIGNATURE: <br /> rn <br /> ft <br /> PRI TED N E! OMPA Y; ��� TI B PRINTED N FICOMPANY: T}p{� PRINTED NAME/COMPANY: TIME <br /> a !(J <br /> ❑ Anah.1m,CA ❑ Amro-,CO ❑ Carson,CA ❑ Casper,WY 0 Corpus Christi TX ❑ Edl.on,NJ <br /> 1250 E.Gene Autry Way 10703 E.Bethany Drive 21730 S,Mmington Ave.-Suhe 201 420 W.First Street 1733 N.Pad1e Island Drive 284 Raritan Carder Parkway <br /> Anaheim,CA 92805 Aurora,CO 80014 Carson,CA 90810-1640 Casper,WY 82601 Corpus Christi,TX 78408 Edison,NJ 088.97 <br /> (714)937-1094 Fax(714)937.1170 (303)751.1780 Fax(703)751-1784 - (310)573-2031 Fax(310)513-2035 (307)2355741 Fax(307)266-1675 (512)289-2673 Fax(512)289-2471 (732)225.6700 Fax(732)225-8777' <br /> 4 <br /> ❑ Hovslon,TX(Env) ❑ Houston,TX(Peq _ ❑ In0anapolls,IN ❑ Lek*Charles,LA ❑ Valparaiso,IN <br /> 6310 Rothesay Ort" -- 8210 Mosley Road 7726 Moller Road 3645 Beglls Parkway 2400 Cum6edand Drive <br /> Houston,TX 77040 - Houston,TX 77075 Indlanepole.IN 45286 Sulphur.LA 70663 - Valparaiso.IN 45383 <br /> (713)690-4444 Fax(713)891}5846 (713)943.9776 Fax(713)943-3845 (317)875-5694 Fax(317)672-6189 (318)683-4926 Fax(318)503-4929 (219)464-2399 Fax(219)452-2953 <br />