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Vlronex Inc Chain of Custody Record <br /> 3002 Dow Ave, Ste 406 <br /> Environmental Tusbn, CA 92780 , <br /> Field Services 1-800-847-6639 <br /> Client Date <br /> Page Of <br /> (z&[Qm— <br /> Address Locabon <br /> Phone — 'l7 Fax Collector Client Project # <br /> Project Manager ~ Batch# Proposal# <br /> N I <br /> i m � <br /> C <br /> N <br /> O <br /> O O O C <br /> O O O O Lf�'1 U) RAJ N <br /> roo co <br /> co <br /> GND co <br /> co co <br /> i` tOD f06 O N <br /> Date Sample Container ¢ ¢ ¢ ¢ ¢ Q ¢ Q ¢ Q p m <br /> CL Q. a a a a_ a. u a a m Comments <br /> Sample ID Sampled Time Type Type w w w w w w w w w w a- <br /> — 14WS 119 <br /> r <br /> s <br /> e <br /> I <br /> Total of containers Notes <br /> .00 Chain of Custody seals Y1N1NA <br /> oshed by'(signature) Date/Time Re iv d b gp�ture) to 1 Time Seals intact? <br /> condt YlNMA <br /> )�i?Q Received good condiGonlcold <br /> Relinquished by (signature) Date I Time Received by (signature) Date 1 Time Turn around time <br /> Sample disInstructions Disposal @$2 00 each Return to client �_ Picku �/ti <br />