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ACCuule <br /> 3700 Lakeville Highway Petaluma CA 94962 <br /> fox 808024 Petaluma CA 9497541024 <br /> .phone 1T07)7f38246 FAX f707176344086 SAMPLE CHAIN OF CUSTODY/WORK ORDER <br /> Client's Name !a Phone lp (r 3 c��a� fp <br /> 9 <br /> Address k V' v% <br /> City,State Zip 1. AA& GQl__ <br /> Client's or Representatives Signature <br /> (signature authorizes the work and terms listed below) <br /> All samples remain the property of the client who is responsible for disposal A disposal fee may be Imposed If client fall: <br /> to pick up samples <br /> PROJ NO PROJECT NAME <br /> REMARKS <br /> SAMPL S gnature)) NO <br /> �`-'� �y f Cr15 L.oitPa1A OF LAB <br /> CON- USE NLY <br /> STA NO BATE TIME � ¢ STATION LOCATION TAINERS //// <br /> LAB NO <br /> O LL <br /> U I C9 <br /> ift Au VI <br /> Relinquish (Srg re) DATE TIME Rec { store) General Remarks <br /> l�roto 5'�P ( � <br /> Rel ul atu DATE TIME ReCeived by Srg tureJ L.L 7 �Z �r <br /> R r by (Srftoo <br /> pA TIME Received by(Signarure) <br /> CLIENT COPY <br />