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Vironex Inc Chain of Custody Record <br /> 3002 Dow Ave, Ste 406 <br /> Tustin, CA 92780 <br /> 1-800-847-6639 <br /> Client - ��E[� C� S+✓' L—/r Date - - �;Z <br /> Page ) Of <br /> AddressZ- cwt ! L /`4�(/1-[nV C,417-/0z/C Project Name S i ec G'/L/ <br /> Phone (WC Z _ C ' Fax (�,��� _ � Client Project# <br /> `� � — ,�� `�Z nSt, 1 Collector <br /> Project Manager `f l C�r _ Batch # Proposal# <br /> N <br /> @ N <br /> Q} � <br /> I �v <br /> N <br /> LOA H <br /> 4y C_ <br /> 0 0 <br /> f9 <br /> 0 0 <br /> Co > o <br /> 0 0 0 o m vii o o Z U <br /> 0w mo a o"o coo (o <br /> Sample Container Q a a ¢ ¢ Q ¢ ¢ ¢ o N <br /> Sample ID4Da. ca <br /> te Sampled Time Type Type W W W W w w W W w ca Comments ° <br /> I v 12 <br /> t rI jl OZ it i> X a3 <br /> �42' l !� H <br /> ©u <br /> It Ttft fh <br /> tI <br /> r tyi ,I <br /> LTir u it { <br /> ' z t i <br /> -aZ <br /> tl a i o� <br /> R,e <br /> lingu ed by (signature) Date 1 Time Received by (signature) Date 1 Time Total#of containers Notes <br /> ti- t t tylQZ r— � 1 71-C-z �G - pain of Custody seals Y/NINA <br /> eli quished by (signature) Yate!Time Recei d by (signature) Date I Time Seals intact?Y/NINA <br /> Received good condition/cold <br /> Relinquished by (signature) Date/Time Received by (signature) Date 1 Time 1 I <br /> Turn around time N <br /> Sample disposal Instructions Disposal @$2 00 each Return to client _ Pickup <br />