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N° OL193CT CFIEMTECH ANALYTICAL LA"TORIES ATORIES (916)635-3962 CHAIN OF CUSTOD 10G-IN <br /> PR ECT NAME 0 RESULTS VERBAL <br /> ~(�✓- w to <br /> PACE CLIENT CHAIN OF CUSTpDY# � a Yes [] No ❑ <br /> OF <br /> DATE SYCHEM rn <br /> TECH SAMPLE LD DATE Tw MATRIX U Vr`• �� � �r TO WHOM x <br /> I D i SAMPLED SAMPLED , e ��?Q} PHONE LL <br /> P •1 - COMMENTS <br /> rn <br /> M <br /> r <br /> t �L "' <br /> LD <br /> T47 <br /> i Lu <br /> z <br /> I O <br /> N <br /> V <br /> 3 � <br /> 6 <br /> REPORT TQ SAMPLED BY ❑ CLIENT (] CHEMTECH ❑ OTHER Q <br /> RECEIVED VIA ❑ FED-EX ❑ UPS ❑ CLIENT ❑OTHER <br /> cc0 <br /> INVOICE TO u <br /> ZIP 0 <br /> r <br /> v <br /> i ATTN Q <br /> o <br /> PHONEZIP <br /> ATTN P O.# <br /> Rehrsqu"w Ay *row., Dazs nme RBGelvad tyr IfMw"oj n <br /> FIELD SERVICES ❑ NO © YES ❑ ATTACHED FIELD REPORT m <br /> w <br /> Rehnqumbad by 44,aa..I Dat*Mrm Reeved by Isipe wo) DISPOSAL OF SAMPLES ❑ NO ❑ YES m <br /> p <br /> 0 <br /> NO <br /> Rel�nqu+9hed by � ,,.y DateJTlrrre OF SAMPLES @IRATE $TOTAL x <br /> 0 <br /> CLIENT Is+ ,auI m <br />