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,w d va n C e d G e o CHAIN OF CUSTODY RECORD Phone: (800) 511-9300 <br /> An Employee-Owned Company DATE: ( ZZ PAGE C of Fax: (888)445-8786 <br /> Analysis Required <br /> Project Manager' <br /> Project Name Email: <br /> Client: Sampler: <br /> Address/Location: Lab Project No.: k <br /> Sample ID/Location/Description Date Time Matrix # Notes <br /> 110N gs I r 1 <br /> is <br /> 3 eP2 <br /> Relinquished by: Date: ryry Time: Laboratory: <br /> i Za <br /> Courier: Received by: Date: Time: <br /> Ca3z <br /> Relinquished by: Date: Time: Received by: Date: f Time: <br /> Relinquished by: Date: Time: Received by: Date: Time: <br /> Requested Tum Around Time: 24 hours 48 hours 72 hours Q.5 days Other: Matrix odes: A=Air W=Water S=Solid <br /> Special Instructions to lab: + Global ID: Authorized Sjgna re: <br /> l <br />