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r.� r <br /> CHROMALAB FILE 4 890265 <br /> CHROMALAB, INC. 2239 Omega Road,# Chain of Custody <br /> 415/831-1788 . Q 3 q <br /> DATE O ! ' - `y PAGE OF <br /> PROJ.MGR. EnZADD STATZ-6y ANALYSIS REQUEST <br /> COMPANY V-HC. LoN�STi�Q c z <br /> �.. � N S V V <br /> ADDRESS -To' 5Z�Z O 2 <br /> aPIe� � CA q4�6� OZ L ►-�' U <br /> in OO co <br /> to eJ u <br /> O O 1` d 0SAhPLERS (SIGNATURE) (PHONE NO.) w z <br /> y H to S <br /> lk cq / �J/ �J �y �NWppnl%O qNv _ O W 6 W _• ►- \ JM W tJ < J <br /> COGS Z6�ZzTi u0 3x oM ..tv uj <br /> Wfvryy 00cc � OQp meq{ w <br /> SAMPLE 10. TE TIME MATRIX LAB 10. a W a a w 2T " w u: < W o w W w i w <br /> Ls - I Q�3ih9 11,20 <br /> PROJECT INFORMATION SAMPLE RECEIPT RELINQUISHED BY I. RELINQUISHED BY 2. RELINQUISHED BY 3. <br /> PROJECT: TOTAL NO.OF CONTAINERS <br /> 65i s. <br /> PCI NO.NO. CHAIN OF CUSTODY SEALS IS,gn ure) (Time) (Signature) (Time) IS gnature) (Time) <br /> RECD GOOD CONDITION/COLD 2APo StAn-r.Y 10 <br /> SHIPPING ID.NO. CONFORMS TO RECORD (Printed Name) (Date) (P(inted Name) (Date) (Printed Name) (Date) <br /> VIA: LAB NO. (Company) (Company) (Company) <br /> RECEIVED BY 1. RECEIVED BY 2. RE EIVED (LABORATORY) 3. <br /> SPECIAL INSTRUCTIONS/COMMENTS: .`. (p N <br /> (Signature) (Time) (Signature) ITime) (Signtimet OI im ) <br /> t 1111�/a� Y (DATd <br /> (Panted Name( (Date) (Printed Name) (Date) (Printed Name) <br /> (Company) (Company) <br />