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GRO ® McClelland <br /> =ern Yta17-13F <br /> CHAIN OF CUSTODY RECORD <br /> 7��000 P�" 2 �� <br /> LA80RATORY I I.AB DATE t7 I& FM 10 !OC}I I <br /> C_JENT 11Q, ze <br /> 11 ?ROJECT G! 4[C4rC�� �P`+ 1 o�n <br /> P•tOJECT MANAGER SAMPLER lSgn.ttae-3`I /=I <br /> i <br /> Laboratory Se[nRia Vessel O of SettWb Piss•systwa Testis Re9uWad <br /> Na_ Na Loeatlon wW Descrtgoor[ date -n— Type, Vessels Motm Method <br /> 13 <br /> U.til _ _ . . .. _ G• ��-[.. , 4 L <br /> 117 �1 <br /> 7-1 <br /> r L <br /> YESSEL TYPE SAMPLE MATRIX TEST R£OURED <br /> areas or @tsmNas stNl a1egr+ 2 h-,neh diameter by 1 3 4 or 3 Innes long A Aw A <br /> I Brau 0-r stemMis susl sir+ve <br /> I%-ncK diamstsr by 4 inches long S Saki 3 <br /> 3 Stamieee steel sisow 1 inch dismoter by a inch"long W Water C <br /> A Amber glass mortis wrth Teflon Iwied screw cap I COO milliliters O Other �? <br /> S Amber gins bottle wrth Teflon imed screw cap 2$0 mdlMen PRESERVATION METHOD <br /> 7 C'eaf glass lei with Teflon lined screw sip 4 or 0 ounces A And mai ice <br /> 7 VOA vtsi 40 mrilibtem B N&KSO, Cs <br /> a Mason lar 1 pint or 1 Quist C H <br /> None <br /> 3 Plesvc bathe 1 Itter 0 Notre I <br /> O Other E Otter <br /> REUNOUiSHED 3 N 14ece 1 GATE. TIME <br />' REUN<JUiSH i SgtunxU a E1VEI]BY ISgntw" GATE R TIME <br /> RELINQUISHED BY (Siurauxei EIVED FOR ORATORY BY ISrgnsturel DATE- TIME <br />' tAETHO0 F SHIPMENT TU AROUND TIME SAMPLE DISPOSAL <br /> Cry A ❑ Retvn to FM �Prppr bnpaei by Lab after dO drie <br />' SPECIAL INSMuc-S N5 <br /> 4AMOUNG INFORMATION <br /> v/tsts FM Copy Yagoss Laboratory Coos Pink R.arn tea FM wrth Raw" <br /> 5855 Oltvas Park Drive • Ventura, California 93003-7672 (805) 650-7000, FAX (805) 650-7010 <br /> w oc t rce.,.M,ria <br />