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Custody Pogo....._„of_ <br /> i0bp <br /> Chain of 4 ustod`,7 � a,eita Mme: ��L'r T=p: <br /> project Name Sta#lo•n No.548 h�,k b4 ff.oho Timm Tem : <br /> EP BVIGEM CO Portfolio: 5 x comirit <br /> $PIaboratory Contract Numb w. Mxtearcvlo ' Evtne�: ..vs,, <br /> Date. / ZI-9-a— Requested Due Date 5 days from date rerdved tffkd Spood, �r 7�iraction: <br /> Send'1Co: 1GFadlity No.: $48 nrul;aaClCvotraeovr: GRS Ca <br /> Lab Mama; ala <br /> RGIN <br /> Facility Addraea: 3612 W.Flu:mmr Lana,Stacktcm Addteaa: ?874 Grd Ookn Dr..Sto 300 <br /> Lab Address: Sita. ARCO 548 SmatammnW.CA 95835 <br /> 819 Staikzt Avs.,SID 8 Sian Lat1i o : e mmu MD: devise a .a <br /> umaor om <br /> Sacruraenoo.CA 95M ifoaenie GlobalM#: T0607700134 CmmItnnt 'oct.No.: 3$455879.00027 <br /> Lalb : Ran$abcl pr��rt Ind Contaar: Foul Su z Consu&nnt'Fetel�ax 416.579ti?0001674�2940 <br /> TelceFn-- 916-921-9600r921-0100 Addrm: P.O.Box 6549 tsrtPNL VeenonEladt-916.717,500 <br /> Repwt Type dc' L+avol: Lovel III XWOgA,CA 945" brmiaaov: Gonodm m <br /> BPIGZM Aa wra No.: Toldt-s= 425.299.88411925 MS= fG1 M WodtRc uum No: <br /> Lab Botdc Ord=No: Matrix 1'txservnlEves Rr:qu�+Otxl NnY1y9iK <br /> R <br /> e <br /> iftt <br /> Uvjo <br /> No. SamplcDgadpdon MOM � � � IAWYANq t'o o Z � = � � Sura a Comt+tr �and <br /> - � <br /> 1 2%T Total Pur IsfIP x kf 1 x 7{ <br /> 2 WF Cat Air �7 k X + 1 X x x <br /> a UT Air ,2e x b 3 z x x x <br /> a <br /> s <br /> 6 <br /> 7 s <br /> s <br /> io <br /> Sump!mr'S Na.rrta: fseor a$ shave i Art . ora rA - ou to e <br /> 5a ler's Com an -URS Co tabor. t� ' <br /> 51u meat Date: <br /> Stsi mcnt McLhod' <br /> SHiprttrrtt 7racJ:irg No: •^' !7 .r+P 'J9' ar o <br /> • S iactetuxiotte: <br /> ' C735tad Scals In Place Yes No Tcr pmmtuxc EIan1t ye'; No 4,e Cooler Tempemtura an Rcocipt` oP Trip$lank yev No <br /> DistnWti= Whitt Cols}'-Laboorutory I Yellow Copy-BP/GEM 1 Pink Copy-CaasultmYVContraetar )3P CCC Rs.S 1 34M2 <br />