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�+ $3g. CHAIN OF CllSTOD OGI <br /> ? 00 1.05 C. CHEMTECH ANALYTICAL LAE( ATOMES (9�g <br /> PRIIMT NAME r uns VERBAL <br /> b co _ Yes ❑ No ❑ <br /> (EFT 0M OF CUSTODY i ` D DATE BY <br /> To <br /> CHM t SAMPLE I D sDATE TWE em MATRIX Z v ��C p w �e� PHONE�- <br /> s COMMEWS <br /> A-0-I� 11- Soy <br /> i <br /> SAMPLED BY ❑ CLIENT ❑CHEMTECH ❑ OTHER <br /> REPORT TO <br /> RECEIVED VIA ❑ FED-EX ❑U P S ❑ CLIENT ❑OTHER <br /> INVOICE TO <br /> ZIP <br /> ATTN Zip <br /> PHON <br /> ATTN P O # <br /> by �DatelTlme Rwe�by �} FIELD SERVICES ❑ NO ❑ YES ❑ATTACHED FIELD REPORT, Al <br /> tt I AlceW by rAPM f DISPOSAL OF SAMPLES ❑ NO ❑ YES <br /> NO OF SAMPLES @RATE $TOTAL <br /> �r <br /> IiENT c MAnW) <br />