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F MarA ialyOcal <br /> w.._4on Ave.Ink..Cl 9X04(UM M 1022 FAX(049!26--1221 rn ' <br /> 10111.C-6.Y 0,..&ft R mImn."97191"� FAX(k;..)27P1GM 0 0 7 917 <br /> MSL,I—.n YMF,6u 4 C-11,W1 W.V..CO 11-M(1141 r1-I"4 FAX(618)r7w"a <br /> 1670 Bwrh 11 rt Sl,804 6.120,M—ii-M 1 6 021 115 4 017 FAX 40"7.-081 <br /> 1404 Cnrp•�Dl„Rha 046,9-Mg..CO 19127 f$IS)SVM" FAX(A 19)60-1604 CU <br /> CHAIN OF CUSTODY FORM Page I of <br /> nt NamelAddress ProjecUPO Number A <br /> Cii3 Analysis Required � <br /> c,L.,i, eta C r+Yj <br /> Project Manag <br /> �C t Il t..+.CCvyiK_T tel' ✓�rb`�— t v.} J <br /> Samples Fax Number: +2 <br /> Sample Sample Container A of Sampling Preservatives <br /> Description Matrix Type Cont. DateiTime Speciallnstructioas <br /> Vol!✓ooh Tn t- ' So cL S/ NA ` A!I .*C <br /> N <br /> a sa-� —rot a N x ,e -ram rorr <br /> �/ few„ <br /> 1 54 <br /> 0 <br /> 0305 a- a Ae <br /> IV eat ZSa- 1J mf-Ic; <br /> Yo? Sa st-6 t z, <br /> 7- X_ <br /> Sf3—!i t •�� c <br /> yrsy <br /> S Q-Z �...fp' •t t— L,,,tal. 1 /7t oo lata �. t' <br /> o <br /> Xco <br /> Yat s s8-.t y/-•S f 12) <br /> ae <br /> Re!inquls By; _ Date Mme: Received by Date[Time. Turnaround Time: (Check) v <br /> .Z el 3 d same day 72 hours <br /> Relin sh y: Dae Mrne: Received by: Date(rime: 24 tours 5 days <br /> 46 hours normalRei 13y ^ Oahe!Time: Received k1 Lab by',. D e fTime Sample Integrity: (Check) <br /> 6 /D Q d 1 /�'Q U ��..!Yb intad on ice l d G <br /> ote By relinquishing samp es to el ar n yt cat;dienl agrees to pay for the serAbes requested on this chain of cueody form and any Itionot ani yses perforTneg on this project. Payment fDr services is <br /> due within 30 days from the cats of invoice,Sample(s)will be disposed of after 34 days. 0114 <br /> C aEx O► t�/mss /jT E4:/L WX_ <br /> Y CO6GB Co <br />