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Advanced6r-ebo <br />CHAIN OF CUSTODY RECORD <br />Phone: (800) 511-9-300 <br />An Employee -Owned CompanyDATE: <br />)` .��. PAGE_ � OFL <br />Fax: (888) 445-8786 <br />QGs <br />Project Mager: <br />Analysis Required <br />Project Name <br />Email: <br />Clien : <br />Sample . 1 <br />z <br />Ad ess Location: <br />t <br />0 A' <br />Lab Project o.: <br />Sample ID/Location/Description <br />Date Time <br />Matrix # Notes <br />2 <br />Relinquished <br />` <br />Date: <br />Z <br />Time: <br />Laboratory, � — <br />E <br />Courier: f <br />f_- <br />Received by: <br />Date: <br />6 b)_ <br />Time: <br />V0)6 <br />Relinquished by <br />Date: <br />Time: <br />Received by. <br />L <br />Date: <br />Time: <br />Relinquished by: <br />Date: <br />Time: <br />Received by: i, <br />Date: <br />Time: <br />1 <br />j <br />Requested Turn Around Time: 24 hours 48 hours 72 hours <br />5 days Other: <br />Mat ri odes: A = Air W = Water S = Solid <br />Special Instructions to lab: <br />Global ID: <br />Authorize ig lure: <br />.✓'� art, �% <br />Page 9 of 10 <br />