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AsSerAcesl- <br /> y <br /> mbia <br /> i:na"Cai CHAIN OF CUSTODY 2- N 990967 <br /> 5090 Caterpillar Road•Redding,CA 96003•Phone:(530)244-5227•FAX:(530)244-4109 COC # <br /> Project# Purchase Order# <br /> fl <br /> J 1 q z L /1. f` 3r , <br /> fRequestytical Method# THIS AREA FOR LAB USE ONLY <br /> Project Name / i { �✓ Lab# Page of <br /> T <br /> Company Name ALab PM Lr Custody Review <br /> C N2uz H ftp L �' <br /> # rae <br /> Proj Manager or Contacty&Phone# Report Copy to. 71�1 Log In L1M5 Verification <br /> 7-. t IJu J / c l cj : 1 i yR <br /> �l0 V �� � � a <br /> Requested Completion Date: Site ID C t nnn <br /> Sample JRetum <br /> O 1 J pH <br /> N /� :, Custody Seals Y N <br /> DisposeA T� v� Ice Y N <br /> Ni <br /> Preservative(to be filled out by customer) QC Level 1 2 3 Other <br /> Type Matrix E <br /> Sampling C G w S A R11 <br /> O R A 0 1 CLIENT SAMPLE ID LAB S .� Y Cooler Temperature <br /> Date Time P B R L R (9 CHARACTERS) QC q <br /> Alternate Description Lab ID <br /> 7 <br /> 51 <br /> X x x. x <br /> �s x ' '� i ��• E x <br /> iC. ( h t <br /> / <br /> RCe, <br /> rp y nd TitlPlease sign and print name) ate ime R r �k �'r �,7 ( F r j�� Qu J (Plea ign and print name) DateLTime <br /> [ cfth g, �(7z rrD <br /> eceived y `G ( I]4 /` I <br /> r {Please sign an rint name) Dat IFime RLIinqui ed By <br /> (Please sign and print name) Date/Time <br /> R oad By (j Psesand print name <br /> CT(�rj ) Date/Time Shipped Via Shipping# <br /> 9� '�() UPS Fed-Ex Other <br /> Special in /on/s:: 2�y�i "gyp <br /> L TP.O. <br /> 3 C 1 ! INVOICE INFORMATION <br /> i 3 � <br /> Bill To <br /> Instructions and Aoreement Pmvis;one nn RPVPY,�a RrrIA <br />