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0• ,M • <br /> N+ ®1 u J d CT CHEMTECH ANALYTICAL LABOR. ORIES (916)635-M2 CHAIN OF CUSTODY- .G-IN <br /> PR ,EC VAME RESULTS VERBAL <br /> I� � <br /> PAGE— CLIENT CHAIN OF USTODY# 0 Q " Yes ❑ No ❑ <br /> OF_ z o y DATE BY <br /> CHEMTO WH <br /> TECH SAMPLE I D DATE 'nME sAMPLEO SAMPLED MATRIX U PFiONOM <br /> I D # c� Q <br /> S AF i—4 sla ;p i s p� COMMENTS <br /> get <br /> DR <br /> 2 R <br /> Ez--c 5 <br /> 3 727 <br /> REPORT TO SAMPLED BY ❑ CLIENT ❑ CHEMTECH ElOTHER <br /> RECEIVED VIA ❑ FED-EX ❑ U P S ❑ CLIENT ❑OTHER <br /> I <br /> ZIP <br /> -- <br /> � <br /> INVOICE TO <br /> ATTN <br /> ZIP <br /> PHONE-- <br /> ATTiV PO # � <br /> Re6n shed by hue) Datefrime Received by (sVehn) <br /> FIELD SERVICES ❑ NO ❑ YES ❑ ATTACHED FIELD REPORT <br /> Retinq ed by {sq-u.1 Date/T{me Received b {siyne we) DISPOSAL OF SAMPLES ❑ NO ❑ YES <br /> NO OF SAMPLES @RATE $TOTAL <br /> Rete unshed oy DatetTne Rdor oraby <br /> CLIENT(SIGNATURE) <br />