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1 <br /> N? 001390 CT CHEMTECH ANALYTICAL LABORATORIES (916)638-3962 CHAIN OF CUSTODY-LOG-IN <br /> 4E_ <br /> ECT NAME to ANALYSISRESULTS VERBAL <br /> f �G� w <br /> LL z <br /> FPAGENT CHAIN dt CUSTODY F cid Yes ❑ iia <br /> Z O <br /> PH d g DATE BY <br /> CHEM TECH SAMPLE E D SAMPIED 5AmPLEt)TE TIME MATRIX cA �� pay ��� WHOM <br /> I D * PHONE <br /> Q a�' <br /> F 1—Q Sl1s/ 'x S"o,/ ek COMMENTS <br /> AFF- Q ti40 <br /> Er-cIf 15 41, <br /> Et- <br /> 3 Ez -C <br /> A,s-- D sss <br /> REPORT TO SAMPLED BY ❑ CLIENT ❑ CHEMTECH ❑ OTHER <br /> RECEIVED VIA ❑ FED-EX ❑ J P S ❑ CLIENT ❑OTHEP <br /> ZIP INVOICE TO <br /> ATTN <br /> PHONE-- <br /> ZIP <br /> ATTN P 0 # <br /> Rel 3 ted by i Date Trine Received by Ispu..y <br /> 5Z FIELD SERVICES 0 NO ❑ YES ❑ ATTACHED FIELD REPORT <br /> Rel3ny by DateRme Received bLsip DISPOSAL OF SAMPLES ❑ NO ❑ YES <br /> [� I - I I I <br /> NO OF SAMPLES_ _ @RATE $TOTAL <br /> Rehnquwshed by 21n Daterrime R by <br /> CLIENT(saAnm) _. <br />