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® ® ® ® ® ® ® ® ® ® IM <br /> Vironex Inc* Chain of Cast y Record <br /> 3002 Dow Ave, Ste 406 <br /> Tustin, CA 92780 <br /> 1-800-847-6639 <br /> oZ <br /> Client„ 1 T Go IzP Date Page Of t <br /> I Address +00 S TO r-�— G�A� <br /> �0 +-+`+y [4hGo4•cl (�A 1"25 ProtectName�I-1:{�y-�h �?-o63Z <br /> E <br /> Phone Z� Fax �)?tea rd 2`1 2a Collector Mt+t Client Protect# ~I'1 111�,Z <br /> Protect Manager M">p2' La" 1 Batch# Proposal# <br /> t KvrIC�-e� i �ravP cow <br /> ro w <br /> d � <br /> H <br /> o U <br /> N C_ <br /> Ql �_ O CJ f6 <br /> C <br /> O O d N O <br /> C C n <br /> a <br /> O N O U <br /> - - O O <br /> ca O O <br /> co ocom m co c <br /> om a <br /> o a coo <br /> Sample Container < < < < < < < < < 0 <br /> Sample ID Date Sampled Time Type Type w w w w W CIL w w w LU a- Comments <br /> 'a }° <br /> U- 1 10 `t °I o�- r.0 �t�-e-}u�t atiC I <br /> i O 5' tc�5i��3 <br /> Ca 10 ` rvl4+eS e -c + <br /> F MW— O <br /> M W- (P 1 E51 <br /> I <br /> I <br /> r <br /> Relinquished by (signature) Date 1 Time Received by (signature) Date 1 Time Total#of containers Notes <br /> 4441 lob, Chain of Custody seals Y/�YNA <br /> Relinquished by signature) Date/Time Received by (signature) Date 1 Time Seals intact?Y/Nl6 <br /> Received good condition!@ <br /> Relinquished by (signature) Date I Time RM(s nature) Date 1 Time <br /> .00 ITurnaroundtime <br /> i Sample disposal Instructions Disposal @$2 00 each etk to c lent Pickup <br /> 4 <br />