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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 ttc Date Page of <br /> Address Z�, C- 9`~ Vl�w :� Y� 4�� Project Name <br /> Phone�±Tc) 4176 105 O Fax—�65-c 5� G3�r' Collector <br /> _ —� Client Project# <br /> Project Manager Jc)*,v' C Rrz�'Y!f „_ Batch# Proposal# <br /> w <br /> N <br /> � N <br /> C r Q) <br /> U <br /> o W m <br /> m <br /> M 0 O # ra <br /> Ql b 00 0 Q O <br /> O b a O r O w � >0 to O <br /> N (o r` CO — r p p_ 0 <br /> 0 0 (O (OSample Container co WQ ¢ ¢ �V} <br /> m <br /> Sample ID Date Sampled Tame typ Type w w w tali w w w Comments ►°- <br /> �- <br /> V„ <br /> 7- 6M r1O <br /> r <br /> et <br /> r <br /> _ - l <br /> � i x <br /> dT $6 1 k <br /> Rle <br /> u ed by (signature) Date/Time Received by (signature) Date 1 Time Total#of containers Notes <br /> _ ZPill <br /> r r ✓C�� <br /> ell qui hs ed by (signature) y (Date Time Re ved b darn of Custody seals YIN/NA <br /> y (signature) Date 1 Time Seals intact?YININA <br />� Received good condition/cold <br /> Relinquished by (signature) Date 1 Time Received by (signature) Date 1 Time <br /> Turn around time <br /> Sample disposal Instructions Disposal @$2 00 each Return to client Pickup <br />