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' 05M 13 "Ifelland <br /> Form Vta.[T/93) <br /> CHAIN OF CUSTODY RECORD �f <br />' LABORATORY OCATION OATS Z- <br /> 4 <br /> <fc v.14LABQV.14-1211-56 <br /> CLIENT PROJECT <br /> Lo 2 o e Avy-m am <br /> PROJECT MANAGER /,N4 m / ' k vk SAMPLER Mignatuesl J <br /> t I aboratoEY sample location sod S+ntpL/('Jlaf Pnnwrva>3ors <br /> +$Lon dale Tb" Vessel No <br /> Na Nts Topa' Vgsre}s Matrix Mettlad TtEw���' <br /> m tu� -- — 3��c t '1 3 OZ. <br /> gots <br /> rl <br /> lob" <br /> i <br /> VESSEL TYPE SAMPLE MATRIX TEST'REOURIED <br /> 1 Brae of of tnlsse steel alssre 2 K-.neh diameter by 1 3 4 or 6 inch[ong A Ar A <br /> 2 &ser or stainless stssl clssw 1St inch diameter by 4 rnchee long S Solid 13 <br /> 3 StaMlsw steel slseve 1 inch diameter by 6 inch"lung W Water C <br /> 4 Amber glae battle with Teflon lined screw cap 1 000 migiktere O Other 0 <br /> 5 Amber glass bottle wnh Teflon l+ned screw coo 260 mrlWitere PRESERVATION METHOa E <br /> 6 CSaar glee 1"wrth Teflon luted screw cap 4 or 6 ounce A Artdrelai ice F <br /> 7 VOA ural 40 milliliters 8 NaHSOI G <br /> 6 Masan lar 1 pint or 1 quart <br /> C HNOy H <br /> 9 Plaatm berth I liter D Nano 1 <br /> i0 Other E 0thar ,7 <br /> RELINQUISHED 8 ISrg t RECEIVED BY [skpmtrei DATE, TIME. <br /> REL1NQUl ISignsnrsl RE E BY S 1 DAT TIME. <br /> RELINQUISH®BY i5pnetva! COVED FOR LABORATORY BY [Sgnatvel DATE. TIME <br /> METHOD�F SHIPMENT TURNAROUND TI E SAMPLE DISPOSAL <br /> Nor ❑ Rehm to FM Propr d+aparr by Lab dtr 60 dare <br /> SPECIAL INSTRUCTIONS <br /> HANOLINQ INFORMATION <br /> WWq FM Copy Yedow Laboratory Copy Print Return to FM with Rawles <br /> 5855 Ohms Park Drive a Ventura, California 93003-7672 a ($0S) 650-7000, FAX (805) 650-7010 <br /> Q*OF 17G1norea,7t3 <br />