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® CT CHF-MTECH ANALYTICAL LA p ATORIES (916)635-3962 CHAIN OF GUSTO' �'�t;-iN <br /> 4+sIJECT N E rn "_ . ANALYSIS RESLiLTS Y€I$I ,L: <br /> ' = P <br /> 787Z <br /> OF <br /> GE CLIENT CHAIN OF WtTODY tR O �+ oti Yes [I No ❑ <br /> C14EM SAMPLE'.D. DATE TIME MATRIX z U d � � �Q `y DATE SY <br /> TECH SAMPLED Sd1MP1 E0 �l O cp �P TO 1NHOM; <br /> 4�fl, PHONE_ <br /> � <br /> COMMENTS: <br /> 0 37 01 K <br /> [9,03701 d 9-f0j <br /> REPORT TO: SAMPLED BY: 13CLIENT ❑ CHEMTECH ❑ OTHER <br /> RECEIVED VIA: ❑ FED-EX ❑ U.P.S. ❑ CLIENT ❑OTHER <br /> ZIP: <br /> INVOICE TO: <br /> ATTN- <br /> PHONE— ZIP- <br /> ATTN• P.O.# <br /> Relinquished by:(sgtn wa) Datel7ime Received by_(sgrowm) <br /> FIELD SERVICES ❑ NO ❑ YES ❑ ATTACHED FIELD REPORT <br /> Relinquished by:(squm j DateTme Received by:(sem] DISPOSAL OF SAMPLES ❑ NO ❑ YES <br /> N SAMPLES [7a RATE $TOTAL <br /> Relinquished by:(sgw.) DateTmehy: <br /> C�L I(W7� <br /> — <br /> TENT(SIGNATURE]: <br />