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Chain-of-Custody Record N Q 1.501 Dates- a4- <br /> 9 ` Page /_ Of <br /> p� G <br /> Project NO.:t_. &57- S ANALYSES REMARKS <br /> Samplers <br /> (Sign re . <br /> G� V N N w o 6 o Addlclonal Comments <br /> m m m m W L <br /> 0 0 0— 0 0 0 0 d �`o <br /> w w w o w w w w tj a' 10 0 <br /> Date Time Sample Number w w wm w w w w F °ryOo <br /> U! LL Q U 2 <br /> I x w <br /> to 2 Y J <br /> I Etc— 5 X 'J <br /> F� 5 <br /> q <br /> X Y ^� <br /> Turnaround time: Results t: Total No.Of containers: 3 L <br /> Relinquls eq.B Is aturel: Date; Relinquls ed by Is r t r 1: Date: Relinquished by(signature): Date: Method of Shipment: <br /> P am P�f Cetl Name Printed Na Laboratory Comments and Log NO.: <br /> �fFr LE Time: ,tel l , j aG\ Time: Time: <br /> COJlpany: // �� Company: Company: <br /> flLO 1}nu `.W5v r *..r1r C, i,(.(0.W l yl <br /> Recel�d by(sl rf?�t e• Date: eivetl by(signature): Date: Receive y(;Ig re): Date: <br /> P nt d Name: Printed Name: Pfin[ tl Na e: <br /> C. Il ^C l \ Time: Time: / �+ lime. Qaomatrix Consultants <br /> 2444 Main Street,Suite 215 <br /> Con )any: Company: Company Fresno.California 93721-2734 <br /> (2091264-e536 <br /> `• ����� <t _ (2091264-7431 FAX <br /> Distribution: Whlte,YeIIOW—Laboratory Pink—Originator <br />