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i wtoOW 7-C4 Woo <br /> HPDR <br /> ENV IR MENTAL Chain of Custody 7;A <br /> PO-2089 <br /> TEC H N OGLE S, L NC. 4 <br /> 2394 Manner Square Drive,Suite 2, Alameda,CA 94501 Page of <br /> 510-521-2684(voice) 510-521-5078(fax) Date 7/ �3 /2D{)0 <br /> Lab Name TEG Analysis Request <br /> Address 11350 Monier Park Place ; <br /> Rancho Cordova, CA 95742 a� a � <br /> o no w opo S $ o = m L <br /> rq <br /> Telephone 916-853-801000 no <br /> o <br /> Samplers(Signatures) <br /> N L F� or'o 00o E ° y i <br /> 5� oo a Ct <br /> M OO E <br /> m o <br /> Sample Number Matrix Location r >° >° Cn J w PC E= a a A z <br /> 0007 (0 <br /> 2 0007 13 i 3 O <br /> 3 oeff l Q <br /> 4 0007 <br /> s 0007 <br /> 6 0007 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Relinquished By 1 Relinquished By 2 Relinquished By 3 <br /> Protect Information Sample Receipt <br /> Project Nameoral No of Containers <br /> Central CA Traction Co <br /> Pmieci Manager Cham of Custody Seal (S gnamre) (Time)( i (Time)(StgnamroTI <br /> ) ( S) <br /> Avakian poiIlG :tl oa <br /> Job No Recd Good Condiuon/Cold (printed Nana) (Date)(Printed Name) (Date)(Printed Name) (Date) <br /> 007-346 <br /> Shipping ID No Conforms to Record (Company) (Company) (Company) <br /> V w C, , vv <br /> Lab No Received By 1 Received B2 Received By (Laboratory) 3 <br /> Via Hand Z JJ <br /> Special Instructions/Comments (Signature) me)(Signature) /(Tone)(Signature) (TIS) <br /> Standard Turn Around Time (FT,. ed ) (nate)(Printed Name) (Date)(Pnnted Name) (Date) <br /> Wl. n, 18 od <br /> �X GFX q (Company) (Company) (isboratary) <br /> �fDfti3 V�6t '�1C�C'�V'LGL 5�r�� Ctc.lut`.m L7r(dwa�t� <br />