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fi y 1 r r r r If C Moil 1 4 2? n <br /> chk( CHAIN OF CUSTODY RECORD <br /> OME <br /> COMPANY: x cusTPROJE TNA UMBER:PROJECT INFORMATION OQ <br /> R lNFORMAtION`� <br /> 0 2 " aG ooh Al <br /> . ./ . <br /> SEND REPORT TO: BILLING INFORMATIONUJI <br /> �� �4 <br /> ADDRESS: BILL TO, <br /> jj <br /> 7 A6 .Df. (/In TGA (V�Qa <br /> v <br /> ADDRESS: ! :` =Qv.Q LAB JOB NO. <br /> PHONE _ 39�S f]� PHONE: � ��I/� C <br /> FAX / "I FAX: PO NO.: I r ' Z <br /> C9zS 37a - 3 o <br /> SAMPLE NO. <br /> SAMPLE SAMPLE SAMPLE C <br /> P' SAMPLE DESCRIPTION '' DATE TIME MATRIX CO VTAI(VER PRESERV. REMARKS /.`pRECiAVlDINS. <br /> S7 <br /> / (0 . <br /> t <br /> c <br /> 6(-16&, Sl X <br /> Zb lW Y17 1 <br /> Lr SAMPLER: ` f�� SHIPMENT METHOD AIRBILL NO <br /> cin U rte[, <br /> cc <br /> REQUIRED TURNAROUND:* I SAME DAY [1 24 HOURS I _ 48 HOURS ,172 HOURS ❑ 5 DAYS L 10 DAYS XJ ROUTINE OTHER <br /> w <br /> 1,RELINOUISHED BY: s;, D T 2.RELINQUISHED BY: GATE 3,RELINQUISHED BY: DATE <br /> 'a SIGNATURE: SIGNATURE: SIGNATURE <br /> 0 <br /> z PRI EDN OM' MPAN ANY - TIME PRINTED NAMElCOTIME PRINTED NAME COMPANY: TIME <br /> 6 " <br /> z t,RECEIVED BY: TE/ 2,RECEIVED BY: DATE 9.RE <br /> C£IVED BY: DATE <br /> SIGNATURE, ©� SIGNATURE: SIGNATURE: <br /> rn <br /> PRINTED NAM COMPANY: / TIME PRINTED NAMEIC PANY: t TIME PRINTED NAME OMPANY: TIME <br /> !� <br /> ❑ Anaholm,CA 13Aurora,CO ❑ Carson,CA ❑ Caspar,WY 13Corpus Chrlall,TX 0 Edison,NJ <br /> 1250 E.Gena Airy Way 10703 E.Bethany Dwo 21730 S.Wiiminglan A—-Suite 241 420 W.First Street 1733 N.Padre Island 0- 284 Raritan Center Parkway , <br /> Anaheim,CA 92805 Aurora,CO 80014 - Carson,CA 90810-1640 Caspar,WY 82601 Corpus ChrisO,TX 78408 Edison.NJ OBB37 <br /> (714)937-1094 Fez(714(937-1170 (303)751-17n4 Fax(303)751-1704 (310)5 13-203$Fax(310)513.2035 (307(235-5741 Fez(307)286.1676 (512)289.2673 Fax(512(289-2471 (732}225.8700 Fax{7325 225-6777 ' <br /> ❑ Houston,TX(Env) ❑.Mauston,TX(Pat) ❑ Indianapolis,IN 11 Lake Charles,to CI Valparaiso,IN <br /> 6310 Rol Drtya 0210 Moslay Road - 7726 Malley Road 3645 Begils parkway 2400 Cumberland Drlvo <br /> Houston,TX 77040 Houston,TX 77075 Indianapolis.IN 46268 Sulphur,LA 70663 Valparaiso,IN 48383 <br /> 713)890-4444 Fax V13)090.5648 (713)943-9776 Fax(713)943.3846 (317)876.5094 Fax(317)872-6109 (31 BI 563-4928 Fax(3181583-4929 (219)484-2369 Fax(219)462-2953 <br />