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mmm m r 7�� <br /> Vlronex In Chain of Cu y Record <br /> 3002 Dow Ave, Ste 406 <br /> Tustin, CA 92780 <br /> 1-800-847-6639 <br /> Cliento P- Date -114107- Page C 01 <br /> Address #006- /mooizT Cr1iC.4E70 j-JwY Ca�ICa,4n C,4Project Name 7` akt:-� Z1754, 5 17� +�- <br /> Phone 77-5=2 21?0 Fax_JZS—927'—Z G 2 <br /> - _ Collector L 44� _ Client Project# 729/'7 719�jj <br /> Project Manager s4czb LL'-�A tpBatch# Proposal# <br /> G) <br /> m <br /> sU N <br /> U 4l <br /> � <br /> iY H <br /> °1 # ro <br /> O7 O b <br /> 0 o O dy o <br /> > <br /> O (6 O <br /> � <br /> oQo � � � v � aoa coo coo 4 � <br /> Sample Container Q ¢ Q Q Q a ¢ Q ¢ o 0 <br /> (t' Sample 1D Date Sampled Time Type Type w w `�° Comments <br /> 'z%5-30' 3 a'z- O <br /> 2 <br /> au ,� <br /> 6 2 <br /> t <br /> Relinquished by (signature) Date 1 Time Receive y oturelw Date 1Ze')L <br /> Total#of containers Notes <br /> O2 y � Chain of Custody seals Ya/NA <br /> Relinquished signature) Date/Time Received by {signs re) Date 1 Time Seals intact? elcold <br /> Received goad conditi <br /> Retmgwshed by (signature) Date I Time Received by signature) Date 1 Time <br /> Turn around time <br /> Sample disposal Instructions Disposal @ 52 00 each Return to client Pickup ` <br />