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N? 001537 CT CHEMTECH ANALYTICAL LABORATORIES (916)635-3962 CHAIN OF CUSTODY- LOG-IN <br /> PROJECTNAM ANALYSIS ID P =AL RESULTS VERBAL <br /> PAGE CLIENT CHAI OF CUSTODY# O ¢ Oy �v �" Yes ❑ No ❑ <br /> OF T— O F- <br /> r�= z Z Q o g DATE BY <br /> CHEM SAMPLE I D DATE TIME MATRIX p�� ��� Q�� �" TO WHOM <br /> TE <br /> c IDC# SAMPLED SAMPLED � a�Q� PHONE <br /> 1117/90 150 r;,,1 ffm COMMENTS <br /> K049A T,14-jr, <br /> o MW —_7 r s' q b k <br /> H <br /> oSS1 NI�J' ? r5ys a0 )0 <br /> J <br /> 1 <br /> I <br /> t <br /> s <br /> SAMPLED BY ❑ CLIENT ❑ CHEMTECH ❑ OTHER <br /> REPORT TO <br /> RECEIVED VIA ❑ FED-EX ❑ U P S ❑ CLIENT ❑OTHER <br /> ZIP <br /> INVOICE TO <br /> ATTN <br /> PHONE <br /> ZIP <br /> ATTN P O # <br /> Relinquished by (signature) Datelftme Received by (signature) <br /> r FIELD SERVICES ❑ NO ❑ YES ❑ ATTACHED FIELD RE=PORT <br /> Relinquished by (sr mrwe) I Date/Time Received by J%nature) DISPOSAL OF SAMPLES ❑ NO ❑ YES <br /> NO OF SAMPLES @RATE_ $TOTAL_ <br /> r Reh utshed by (signature D terrime ReC ed for Lab ato by <br /> �Vq1 CLIENT(SIGNATURE) <br /> 1 <br /> i <br />