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Chain-of-Custody Record N' liTo <br /> Date 6--12 f �� IPJW <br /> Project No C D 77 ANALYSES REMARKS <br /> Sampl rs ISlgnatur 1EsAdditional Comments <br /> o N % r (OAPP,QA samples,etc) <br /> 10 00 Ono Ano ONO a' c <br /> °�' <br /> D 'O U U Q C <br /> o 4 <br /> W fi <br /> d m m a a V 2 U aUi U <br /> N p <br /> Date Time Sample Number o a a a a a x a a o te u a <br /> Lon w w w w r .., (j� V M a z <br /> pt W -TR-Av6L. € t-AaJ I<- <br /> s-1 z oq,, ;2, <br /> fqS 3 V-5Pr n- RON BUx�N <br /> 09 5.21 S 05til, V Ek8AL. RESu t-7 TO <br /> d 9 lv 0 Irl 6 6066 Foo X)6 Pw o� <br /> 10,11 7 TD ri AJ A L 200,a-r <br /> ►6' q3 s z <br /> 1a'y: -ZPLASMArnC A4?HS FOP, <br /> fd <br /> IO'' Io zCI�� <br /> q�L go IS �s u L <br /> 11,gI 3 <br /> 11=11 12-[x-13$ 2- <br /> 13 <br /> 13 X z <br /> 5-1Z j1'�IB I ► z sz4o <br /> it <br /> Turriarouncl time Results to <br /> 1 A () A4 VEEN C l4�E Foo Mrs Total No of containers z <br /> p W A L 0 <br /> Relln [shed by 15i atur 1 ��D.iaate R nq i e y(signature) Date <br /> Relinquished by(signature) Date Method of Shipment <br /> Prl d Name Pr t arl] Printed Name Laboratory Comments and LDg Na <br /> G l]w�!T' � P-K Time � � r,�p Time Time <br /> Com 1y ��-- - - -- --- - - ��;I� Comail- -— - - -- - �� qa Company - - -- ------- ---- - - - -- - <br /> � Tler)C ?.� <br /> Rece e y Is ure) Date Recei Q (Signa r Date RBCeIveQ by(signature) Date <br /> Prin d ame Print d Name , Printed Name <br /> � 1�n1�o Time t' Li ��� � Time Time "� '-'— Gaomatrix Cansuli�ants <br /> 2444 Main SLrewt Since 215 <br /> Con Company Company <br /> Fresno C(al{fOrr119 93721-2734 <br /> 1 4� "y� �� [2©91264-2535 <br /> VY��` V —JI [2091 264-7431 FAX <br /> Dlstributlon Whlte,Yellow-iaboratory Pink-Originator <br />