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vironex Inc Chain of Custody Record <br /> 3002 Dow Ave, Ste 406 CE 1 <br /> Tustin, CA 92780 <br /> 1-800-847-6639 <br /> Client s Date 31- G Pae Of <br /> AddressZ- C1 r Z9 v G G Project Name -- c <br /> Phone 0651 } �!Z GSR Fax (�5�7 � '^ Collector Client Project# <br /> Project Manager Jo IJ Batch# Proposal# <br /> N <br /> DS � <br /> O <br /> w � <br /> m o 0 <br /> m <br /> m � o <br /> 0 0 0 G <br /> o N 0 d to 0 O d OV <br /> (9 O <br /> c:' <br /> m com W m 0 CD <br /> Sample Container a Q a ¢ ¢ Q a ¢ ¢ <br /> Sample ID Date Sampled Time Type Type W w EL <br /> W W tail w `; ri Comments <br /> r !I !! 1 <br /> k V1 Ilk <br /> cl,2 VL-p <br /> - a — cap ' rr rr r X <br /> Q ' r rl r <br /> s II rt itX X YX <br /> ' " "c X <br /> 1L-,-, i <br /> - 5 C' rl f t 1t 7C2L X <br /> e` r It r{ <br /> Rel qurs d by (signature o Date 1 Time Received by (signature) Da 1 Time Total#of containers Notes <br /> Chain of Custody seals YIN/NA <br /> R iin uished by (signature) Date/ ime Rec ed by (signature) Date/Time Seals intact?Y/NINA <br /> Received good condition/cold <br /> Relinquished by (signature) Date 1 Time Received by (signature) Date/Time <br /> Turn around time r <br /> Sample disposal Instructions Disposal @$2 00 each Return to client Pickup 4 <br />