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CLS Labs <br /> Subcontracted Mlcroblology Assays <br /> pertommd by Ot <br /> CytoCulture Environmental Biotechnology N <br /> CHAIN OF CUSTODY FORM N <br /> Project Varve Project No CLS Labs Order/LOG tN #' a <br /> CLS Labs Client Organization CGS Labs Project Manager <br /> Address to Send Results o <br /> 12d Aj4Hr, <br /> Client Fax for Sending Data Client Contact!Project Mauger <br /> 010 E5s 0 <br /> Client Tel for Follow-up, Client Sampler/ Recorder <br /> � 3S - �_')0 f <br /> sampte I D. Sampling Matrix Analyses Requested <br /> Indicate target Date Time Soil Water H)drocarbou Total pH DO NH3 PO, NO, SO, Other Tests or <br /> Hydrocarbon range Degrading Heterotrophic Comments <br /> Bacteria Plate Bacteria Plate <br /> Count Count <br /> i <br /> Chain of Custody Record Signature of this form constitutes a firm Purchase Order for services Paymeut DUE on Reporting Date <br /> Relinquished z Date/Hr Received by Dateft <br /> Recet for Cy oCutture Lab by Date/Hr ` CytoCutture Tel 510-233-0102 Please fax Chain of Custodv form <br /> PXA Lab Services fax 10-233-3777 to CytoCulture prior to delivery <br /> Cry q46G(- S}1`? <br /> WI <br />