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InKLEINFELDER ' <br /> PROJECT NO. ice+,T PROJECT NAME i6 RECEIVING LAB: <br /> V l! <br /> 11 --rROMifte,S gL NO. TYPE <br /> L.P.N0. SAMPLERS:(Signature/Number) <br /> (P.O.NO. L OF OF �y <br /> INSTRUCTIONS/REMARKS <br /> ! _ CON- CON- <br /> DAZE SA!A kW I.D. U' TAINERS TAINERS \ V �- <br /> TIME SAMPLE I.D. MATRIX CJ TA-� <br /> Y <br /> MM/DD/YY HH-MM-SS d' <br /> 3o lAlkr,,A <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 6 <br /> 9 <br /> 10 . <br /> i 1z <br /> 13 <br /> 14 <br /> 15 <br /> 15 <br /> 17 ~ <br /> f <br /> 18 <br /> Reh qq ished by:(Signature) Date/Time e Received by:(Signature) Irstructions/Remarksi Send Results To: q <br /> !(LEINFELDER <br /> elinquish by:(SiF9aAtVurqT Datemme 'Received by:(Sigriature) 2825 EAST MYRTLE STREET <br /> 5TOCKTON, CA 95205 ' <br /> (209)948-1345 <br /> 'Relinquished by`:(Signature) Date/Time Received for Laboratory,by:(Signature) Attn: - e <br /> M )Q-01'jp'Q� LOU T--Z-X,IJ9fSf—,W, <br /> M-60 ^ite-Sampler Canary-Return Copy To Shipper Pink-Lab Copy <br /> CHAIN OF CUSTODY N! 2 388 <br />