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Chain of Custody Record <br /> AnalyticalTeAnologies,lnc. <br /> San Diego,CA • Los Angeles, CA • Phoenix,AZ • Seattle,WA 3I 7 lY <br /> DATE PAGE ( OF <br /> CLIENT Cl ^ � PARAMETERS OTHER y <br /> ADDRESS 6 7r <br /> U V Q <br /> a z z <br /> PROJECT C .a m F w Z a a a 2 <br /> SAMPLERS(SIGNATURE) Q. = y 2m Q— CO �' U OBSERVATIONS/ '` <br /> W na DU W W,. W C COMMENTS <br /> �(,�t.._ �i ✓_iL.L �1-c.i. ,fir e. .� N�n , ,� jJ U 0O 2� fj I�O� f D <br /> ll 2 GF Z nL 6 y0 1. j- jd 1 2 <br /> J 1-0 w to p <br /> SAMPLE NO DATE TIME LOCATION v sf p ax m$ a >w >10 F- - z <br /> 1 3 i 41 a s 1 4 <br /> 'l4i. 14 - f r ti <br /> I <br /> RELINQUISHED By DATE RECEIVED BY , r DATE RELINQUISHED BY DATE RECEIVED BY DATE TOTAL NUMBER • <br /> r I E OF CONTAINERS <br /> METHOD OF SHIPMENT <br /> 610natura— �,. Signaa ture Signature Signature <br /> TIME TIME TIME <br /> Printed Name Printed Name \\ Printed Name Printed Name SPECIAL SHIPMENT/HANDLING <br /> 14 5'j �..t.,p v.+r y.�-.:9„� ` OR STORAGE REQUIREMENTS <br /> Company - r�,;! Company r Company Company <br /> RELINGUISHED BY DATE RECEIVED BY DATE RELINQUISHED BY DATE RECEIVED BY (laboratory) DATE <br /> Signature Signature Signature Signature <br /> TIME TIME TIME TIME 'r <br /> Printed Name Printed NamePAnted Name Printed Name <br /> Company <br /> ,any o.,any <br /> Analytical Technologies, Inc. <br /> DISTRIBUTION: WHITE, CANARY -ANALYTICAL TECHNOLOGIES, INC. • PINK-ORIGINATOR <br />