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CD <br /> N <br /> Client NamefAddress: Project 1 PO Numb,=tANk49seS <br /> Antea GroupfUPRR .�.:i' <br /> 1155 N.First Street,Suite 201 '' ;z i it <br /> San Jose,CA 95112 <br /> o cv <br /> Project ManagerlPhone N=ber. Phone Number:800-477-7411 > <br /> Sara Sichleyl4084054947 a <br /> a vI of <br /> ampler_ Fax Number,468-318-6260 m r a <br /> Steve MbrdemtDavid Sisak o < <br /> u <br /> Sample Sample Contaner it Of Sampling Special <br /> Desrrtption Matrrx Type Containers D2tefrrmE Preservafkm Instrllctiorm <br /> 41'I5114; <br /> SO-2432-S-1d1.5-041M4 SO gtassjar11016 None Ix x <br /> 411564; <br /> 50-2432.B-1d4.5.041514 SO glassjar 11026 None x x <br /> 4115114; <br /> So-2432-S-2d5S-041514 So glass jar 1 10`55 None x x x <br /> 2432-8-3d5.aR41514 So 4145114, <br /> SO- <br /> glass jar 1 1140 None x x x <br /> 4116!14; r <br /> SO.2432-B5d5.5-041514 so glass jar 1 1215 None x x x <br /> N <br /> g2 14; <br /> s0-2432-C3-11x11.5-041514 SO glass jar 1 None F x 0 <br /> 54 X432-81146 S A4351a 80 9tass jar ? 32,1 Nage x % N <br /> 4!15114; 720-56810 Chain of Custody a) <br /> S0-2482-8-14d5.5-041514 $O Bless jar 1 1419 None x x x x <br /> Z� <br /> (0 <br /> 4115/'1 4; d <br /> SO-2432-S-1346.5-g4.i514 So x % x <br /> giassjar 1 1450 (Sone <br /> 4115114; <br /> St)-2432,3-12d1."41514 SO glass jar f 1515 None x z x <br /> Reflnquished By: r Received by: Tumamund Time: (che6o <br /> ❑atsri-iree- �� _ _ e g f,'�„ st �7 IIate1T¢nE: <br /> Lis?� :✓ <br /> _ r <br /> Serve Day 72 Hours <br /> RelhgWshed By: € Received by: 24 Flours 5 days <br /> Oatefrrrse: Daterrime: <br /> 48 hours norm-at <br /> Relelquished By: Received in Sample Irdtegrrty: (Check) <br /> Datefrpre: Lab by; <br /> lnta On Ice: Custod 8eai: <br /> Note:By refnqutshing samples to Test Amecoa,client agrees to pay forthe services requested or.this chain o€custody form end any addl ional analyses perf©rmad an this project.Payment for servtoes is due Within W days Yom <br /> the date of invoice.Sample(s)w1l bE ds-sposed of after 30 days. <br />