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■� Chain of Custody Record <br /> AnalyticalTec�tnologies,lnc. <br /> San Diego,CA • Los Angeles,CA Is Phoenix,AZ Is Seattle,WA .-/, . / , <br /> DATE PAGE Or <br /> CLIENT f �'� " = PARAMETERS OTHER <br /> ADDRESS I ' I - Ir <br /> - <br /> n V Z <br /> Q 2 2 f <br /> PROJECT : : - r.. ;.r m f, Iz N N Q Q 2 <br /> SAMPLERS(SIGNATURE), ra R_ m m mcOi OBSERVATIONS/ <br /> J F Q f¢ Qy—fa y O O - LL COMMENTS <br /> O <br /> X <br /> r f O J R O CQ £Q OF F�. k- <br /> O W <br /> / 1 W Z J F"� y5 N Jp �ry f <br /> 10 <br /> SAMPLE NO DATE TIME LOCATION V a 2 (7 O W>. m� a 0 <br /> 1p >1D 2 <br /> r <br /> 16. <br /> B�KUIVcf I � I <br /> O pro J L <br /> �1f �t�l <br /> RELINQUISHED BY DATE RECEIVED BY DATE RELINQUISHED BY DATE RECEIVED BY DATE TOTAL NUMBER <br /> -! 1 OF CONTAINERS <br /> �rq , <br /> METHOD OF SHIPMENT <br /> Signature Signature Signature Signature <br /> TIME TIME TIME TIME <br /> Printed Name Printed Name Printed Name Printed Name SPECIAL SHIPMENT/HANDLING <br /> OR STORAGE REQUIREMENTS <br /> Company Company Company Company <br /> RELINQUISHED BY DATE RECEIVED BY DATE RELINQUISHED BY DATE RECEIVED BY(laboratory) DATE <br /> Signature Signature Signature Signature <br /> TIME TIME TIME TIME <br /> Printed Name Printed Name Printed Name Printed Name <br /> Company Company Company Analytical Technologies, Inc. <br /> DISTRIBUTION: WHITE. CANARY .ANALYTICAL TECHNOLOGIES, INC. • PINK-ORIGINATOR <br />