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Anal ticalTechno�o �es,lnc. SAN MEGO, CA 92 DRIVE Z <br /> SAN DIEGO, CA 92121-1709 Chain of. Custody DAT / 'PAGE OF-1-- <br /> 21 <br /> Y 9� (els)4e8-9141 <br /> PROJECT MANAGER: 0A0& 6 Recommended Quantity and Preservative (Provide triple volume on QC Samples) <br /> COMPANY.' <br /> B05 � Ro R0 vo v__okN c__i0kN `o0kN `ADDRESS: /60129 h h h <br /> ro o vokN oohE v <br /> l <br /> oSE oSEoo No <br /> ILL TO: <br /> tF <br /> h V) <br /> O <br /> COMPANY: <br /> ADDRESS: /(001 <br /> c� 33� <br /> ror+1 rvA o Q. 0 <br /> c N � 0 0 <br /> E53 o7/! ) .355-- -33 <br /> in <br /> SAMPLERS: (Si n� PHONE NUMBER x m g o m N m 2 a a Nw U d o o <br /> SAMPLE/D SAMPLE ME MATRIX LAB ID m °� m o o o v <br /> DATE a o co o co m o ¢ o x o a m c� a o a 2 <br /> aJ 6/ ,tr`s6 <br /> u1 0� <br /> �" RELINQUISHED BY. 1. RELINQUISHED BY.. 2. RELINQUISHED.BY.. 3. <br /> PROJECT INFORMATION AMPLE RECEIPT <br /> PROJECT NUMBER: ' ^ TOTAL NUMBER OF CONTAINERS S nature: Signature: Time: Signature: Time: <br /> PROJECT NAME. co//! CHAIN OF CUSTODY SEALS Y/NINA /V4 Prin(ed Narge: a : Printed Name: Date: Printed Name: Date: <br /> PURCHASE ORDER NUMB R: SEALS INTACT? YIN/NA 4044 1 <br /> VIA: RECEIVED GOOD GOND./COLD Company: Company., Company: <br /> TAT'024HR 048HRS 072HRS ❑1WK 02WK LAB NUMBER .RECEIVED BY `-1.. RECEIVED BY: . '2. 'RECEIVED BY.'11 -3." <br /> .,� _ ,��� SAMPLE DISPOSAL_INSTRUCTIONS , ='. �. Signature: Time: Signature: Time: Signature: � Time: <br /> ATI Disposal @ $5.00 each 0 Return ❑ Pickup <br /> _ � C� /1� �1 Gl / j) C Printed Name: Date: Printed Name: Date: Printed Name: Date: <br /> Comments: <br /> F� lC�] (� �j}/�/.�// Company: Company: Analytical Technologies,Inc. <br /> • I / l — l DISTRIBUTION:White,Canary.ANALYnGAL TECHNOLOGIES,ING •Pink-ORIGINATOR <br />