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CHAIN OF CUSTODY R RD <br /> CUSTOMER INFORMATION PROJECT INFORMATION �4 <br /> COMPANY �; Cir, _ PROJE _VPnMBER C I�A� 2r 7r N A, <br /> 1 i cc � 1p <br /> SEND REPORT TO BILLING INFORM TION W o <br /> S h�.� Lura Hwy <br /> ADDRESS J � o �1, �vv HILL TO fa. E. <br /> u(_J� c}� �1 Ua ADDRESS C16).., <br /> u- =Q �� LAB JOB NO. <br /> W <br /> PHONE PHONE m - <br /> FAX �1 r n � FAX PO NO Z { `u <br /> f * SAMPLE SAMPLE SAMPLE <br /> SAMPLE NO SAMPLE DESCRIPTION DATE TIME MATRIX OOI�ITAINER PRESERV REMARKS/ PRECAUTIONSil <br /> -2 �1--l l a'z� x X <br /> j� <br /> 2,5- <br /> CJ 3 0- <br /> $ 3 L <br /> os- <br /> 4 <br /> 2 <br /> :3 SAMPLER "'Y SHIPMENT METHOD AIRBILL NO <br /> m <br /> uj <br /> LK REQViREO TURNAROUND Fl SAME DAY L 1 24 HOURS L 49 HOURS { 1 72 HOURS 5 DAYS I ] 10 DAYS I I ROUTINE OTHER <br /> c- 1 RELINQUISHED BY DATE 2 RELINQUISHED BY DATE 3 RELINQUISHED BY DATE <br /> 'a SIGNATURE SIGNATURE SIGNATURE <br /> M PRINTED NAMEICO PANY TIME PRINTED NAMEICOMPA el C TIME Z PRINTED NAMEICOMPANY TIME <br /> `D <br /> z 1 RECEIVED BY DATE 2 RECEIVED BY DATE 3 RECEIVED BY DATE <br /> D SIGNATURE SIGNATURE SIGNATURE <br /> PRINTED NAM OMP Y TIME PRINTED NAMEICOMPIWY TIME PRINTED NAM5COMPANY TIME <br /> cr <br /> �L Cp3D <br /> ❑ AnaMim GA ❑ Auram W 13Canen CA ❑ Caspar Ivy ❑ CoqChrist!TX ❑ Edi a NJ <br /> 1250 E Gane Autry Way 10703 E Bethany Drrrkm e 21730 S W&nwpAve Sudo 201 420 W Fret$veal 1733 N Padre Idaad Or" 294 Raman Cerder Parkway <br /> Anaheim CA 92805 Aurora CO 80014 CarsonCA 90810-1540 Casper WY 82601 COrpas Chnsh TX 78408 Edison NJ 08837 <br /> (714)937 1094 Fax(714)937 1170 1303)751 1780 Fax(303)751 1781 (310)5,3 2031 Fax(310)513 2035 (307)235 5741 Fax(307)266 1676 (512)289 2673 Fax 1512)289 2411 (732)225 6700 Fax(732)225-777 <br /> ❑ Howron.TX Mn.) ❑ mousm Tx(Peq 17 mdlsmpolts N ❑ lake Chut"LA ❑ V.Ip.r.I—IN <br /> 6310 Rolhway Onus a2t0 Motley RoW 7728 Muller Road 3645 Beyhs Parkway 2400 Cumberland Drive <br /> HOU51M TX 77040 Houston TX 77075 Inrbanepuke IN 46268 Sulphur to 70663 Valparawo IN 46383 <br /> (7131 690-4444 Fax 1713)690 5646 (7131 943 9776 Fax(713)943 3846 (317)875 5894 Fu(317)872-6189 (3 18)W-4926 Far'(318)383 4929 (219)464 2369 Fax(219)462 2953 <br /> ORIGINAL <br />