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N 0 001641 CT CHEMTECH ANALYTICAL LABORATORIES (916)635-3962 CHAIN OF CUSTODY- LOG-IN <br /> Y <br /> PROJECT NAME a ANALYSIS I P If RESULTS VERBAL <br /> Cc <br /> _ POFGE CLIENT CHAIN OF CUSTODY# 0 a � ��� ac; /Yes 0No ❑ <br /> �. <br /> Z p QO o Co DATE BY <br /> CHEM SAMPLE I D DATE TIME MATRIX 0 �Cj 44TEC <br /> I D H SAMPLED SAMPLED O �,Q Q��v PHO EOM <br /> COMMENTS <br /> 7/4- <br /> I <br /> yY <br /> fi <br /> Y <br /> f <br /> t <br /> f <br /> �r <br /> h REPORT TO SAMPLED BY ❑ CLIENT ❑ CHEMTECH ❑ OTHER <br /> RECEIVED VIA ❑ FED EX ❑ U P S ❑ CLIENT ❑OTHER <br /> S <br /> ZIP <br /> INVOICE TO <br /> ATTN <br /> PHONE. ZIP <br /> ATTN Po # <br /> Relinquished by (s,gnaMe) DatelT(me Received by (S,gnamral <br /> h� FIELD SERVICES ❑ NO ❑ YES ❑ ATTACHED FIELD REPORT <br /> Relinquished by (signature) Datemme Received by (s,pnauure) DISPOSAL OF SAMPLES ❑ NO ❑ YES <br /> NO OF SAMPLES @RATE _ $TOTAL <br /> Relmqutsh by (signature) ate/Time Recety for Laboratory by <br /> w ( I <br /> ` CLIENT(stGNATUR EI <br />