By signing this Chain of Custody Agreement, customer …



CHAIN OF CUSTODY

|Client Name:       | |Sample On Ice |Data Format Requested | |

| |Invoice To:       |Yes No | |Report Format |

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| | |Sample Disposal |Results Only |Fax |

| | |Client MAEL | | |

| | | | |E-mail |

| | | |QC Package |PDF |

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| | | | |Portal |

| | | |NJRDD + Hazsite |Posting |

| | | | |Only |

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| | | | | |

| | | |NJFDD + Hazsite | |

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| | | | | |

| | | |MDE | |

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| | | |Excel Summary | |

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| |Purchase Order #:       | | | |

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|Address:       | | | | |

| | | | | |

| | |Site Location | | |

| |Project Name:       | | | |

| | |NJ PA | | |

| | | | | |

| | |DE MD | | |

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| | |Other      | | |

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|City, State, Zip:       | | | | |

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| |Bottle Order #       Quote #       | | | |

|Contact Name:       | | |      |      |      |      |      |      |

| |Regulatory Program |Turn Around Time | | | | | | |

| | | | | | | | | |

| |DERBCAP PA UST | ................
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