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ggsZn ® McClelIand <br /> =arm Vta.(7t93) <br /> CHAIN OF CUSTODY RECORD <br /> X m coo <br /> LASGRATORYL./.8 T+Q LOCATIO DATE C ` FM JOB Ne <br /> CLIENT PROJECT ^f /V) <br /> ultu <br /> �L Jrh <br /> PROJECT MANAGER 41. Lef <br /> f . SAMPLER(Sgnan+ ) <br /> Lsl7ars17Sa,/ Semple' Vasaai No err! Samofs PraservsmR Tet►ts.Regwrt�d <br /> Na No Locstla7T and 08210r=01`11 Date Tarns Type Vessels Mawx 1Aatt+od <br /> 45 <br /> rexw-1 k LI tf C' <br /> Si <br /> r t Tl� Zc ll <br /> VESSEL TYPE SAMPLE MATRTX TTS'r`REQtRRt� <br /> 1 Brass or atstrtieas steel si-aw 2 A inch diameter by 1 3 4 or 8 mch-e long A AM A <br /> 2 Brsee or-tunlees strrl SM-w 1,L melt dramet-r by 4�nchea loop S Sol1d 3 <br /> 3 Stainless Steel al"ve 1 inch diameter by 3 inches long w Water C <br /> 4 Amew bless bottle Mirth Teflon hoed screw Sao I DOD milliliters O Other 0 <br /> 9 Amber plea bottle Mom T-fien lined screw cap 290 miiidrters PRESERVATION METHOO E <br /> d C,a-r gfese ler with Teflon bred screw cep 4 or 9 ounces A Artificial ics F <br /> 7 VOA Mrd 40 m4lrhters B NaH50r G <br /> 9 Mason jet 1 pint or 1 auart C HMO, H <br /> 9 plastic bottle 1 Irter D Nene I <br /> 10 Other E Outer J <br /> REi3NQUISN Y l wnsc V / DATE. TIME <br /> AEUNQUI BY Isgnatt=et R ED 9Y,15gnseve�l,!" SAT i �+ TIME <br /> RELINQUISHED 9Y (Swnanow Csvm FOR L oicRATOnY 8Y t5wrtett+-1 DATE <br /> /l�J TIME <br /> / S <br /> IMETHOD OF SHIPMENT TURNAROUND TTM SAMPLE DISPOSAL. <br /> L� U+ {st ❑ Return to FM )i Prawn disposer by Lep after eO dors <br /> SPECIAL INSTRUCTIONS <br /> HANDLING INFORMATION <br /> 1 VNwte FM Copy YSeova Laboratory Ceoy P1r"t Return to FM wnh Raw va <br /> 111 <br /> 5855 Oltvas Park Dnve a Ventura, California 93003-7672 a (805) 650-7000, FAX (805) 650-7010 <br /> IWOLt7Cewwry 713 <br />