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• t , <br /> cgg_ren <br /> 29594 <br /> tart FOR LABORA TTRY USE ONLY <br /> Laboratory Project No.: `�`�U Secured: <br /> CHAIN OF CUSTODY RECORD Storage FreezerrlD. ID: �� Yes <br /> Storage FreezerlD: No <br /> Project Name:Fuge -Te-X e — 7-rar Project#:Q/. U 6490'.-1, 16 , UDU Sampler._� Q�•� <br /> (Printed Name) (S,nature) <br /> Relinq ed by:(signalu a d Print Name) e eceive y:(Signature and Printed Name) yy x Date: �/ �� Time: /_i; <br /> jG /� , <br /> Relinqui hed by:(Signature and Printed Name) Received by:(Signature kd Printed Name) Date: Time: <br /> Relinquished by:(Signature and Printed Name) Received by:(Signature and Printed Name) Date: Time: <br /> Relinquished by.(Signature and Printed Name) Received by:(Signature and Printed Name) Date: Time: <br /> G\ <br /> SHIP TO: Method of Shipment: Circle or Add 5 G\ <br /> -McLaren Analytical Laboratory L� I I Analysis(es) ��e 5 �G\ \ a)Identify specific metals <br /> I 1101 White R�xk Road / rt/�r RequestedJorma a��� G0 �G \ G\ requested under Special <br /> Q <br /> Rancho Cordova,CA 95610 Shipment ID: ea J°\ �G\ r; C��' �� \ �' Instructions <br /> (916)6 38-3696 p cam <br /> FAX(916)638-2842 <br /> Sample ID Sample Description `per ryo Po Qo 0o ao �o �� �p �Q �° <br /> Number Dale Time Description `��o o�000a\0000�o^o\o�rLa\��rl`OOQ�\�Q�O^� o� e`a°tea�or� pc�� QOc`� Containers) FOR LABORATORY USE ONLY <br /> p o `° o ro o e ro a o Q G 5 TAT # Type Lab ID <br /> 1 K/'/ /l O s E z-l S / ' B `�� (! (: 5/.......... ........ <br /> 2 8Y37 111 S " .......... ........ <br /> 3 98 9 //,/o s6-2 g :.��.,............. ........ <br /> / ��u ........ <br /> 5 <br /> ........ ........... ........... ........ <br /> 6 <br /> ............ <br /> 7 <br /> ........ ....................... ........ <br /> 8 <br /> ........ ....................... ........ <br /> 9 <br /> 10 <br /> Sample Archive/Disposal: TAT(Analytical Turn-Around Times) 1 =24 hours 2=48 hours 3=1 week 4=2 weeks <br /> Special Instructions/Comments: -_ <br /> 25 Laboratory Standard Container Types: B=Brass Tube,V=VOA Vial,A=1-Liter Amber,G=Glass Jar,C=Cassette, <br /> - O=Other <br /> ❑ Other SEND DOCUMENTATION AND RESULTS TO(Check one): <br /> Project Manager/Office: l T rr�t 6 P,� �u-r ��� C o�)W o. <br /> FOR LABORATORY USE ONLY. Sample Condition Upon Receipt: n,i„,r rrr t ❑ Client Name: <br /> - - ----- <br /> Company: <br /> Address: <br /> — ------------- - —--- -- - — — - - — --- Phone: ( ) Fax: <br />