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} CHAIN OF GUST' ;iY RECORD � � � ,�4_ <br /> SRM- est Inc. <br /> 001 P Street • Suite 200 • Sacramento, CA• 95814-5213 • (916) 444-9378 • Fax (916) 444-5313 Page l Of <br /> PROJECT# PROJECT NAME MATRIX REQUESTED PARAMETERS <br />'AMPLER:(PRINT NAME) ( GN TURIL <br /> x?0 S'5 elCX) <br /> RECEIVINQ LABORATORY <br /> C o4- ` h <br /> a SAMPLING W w SAAMPl_ING <br /> SAMPLE 1,13. DATE . TliulE2C - <br /> METHOD v VOLUME A <br /> k w- <br /> iE UISHED (SIGNATURE) DATE TIME I ACEIVED BY DATE TIME FIELD REMARKS <br /> 3 z3�s z 7hJ 166S}a � as per 1, vr! <br /> 3 1 QUlf ED BY(SIGNATURE) DATE TIME R EIVED BY DA E TIME a,JZ3q�- <br /> �3 l yd <br /> E INOUI D BY (SIGNATURE) . .. DATE TIME RECEIVED BY DATE TIME <br /> REMARKS ON SAMPLE RECEIPT ERM REMARKS SEND REPORT TO: <br />❑ ROTTLF INTACT GI CUSTODY SEALS ❑ CHILLED f s P <br />❑ PRESERVED ❑ SEALS INTACT ❑ SEE REMARKS <br /> nrinin-il to grrnmn:inv camnlnr f'nnary - Prniprt RAnnnnnr Pink - Finlrl r.nnv <br />