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Page I of LABORATORY F 'VICE AGREEMENT Chain-of-Custo Record <br /> U-Haul Facility Number_ U" �+ '�Q�" i�3 Consultant Project Number <br /> Columb U-Haul Facility Address L-OD! <br /> f Consultant Name si-A CnIJKymEN <br /> ML <br /> Anoliyicol U-Haul Contact(Name) Rp-ta n"Ns7N Address 8649 F. KOyAtpAwK�" S•C <br /> V §L FA� Servces (Phone) &-, � 3-44q7 Project Contact(Name) DfN/ECIsL4F8 ife <br /> 1-800-695-7222 <br /> U-Haul Project# (Phone) (dUa-gg3- 3g5ZS (Fax) &d;t—#43-1A1y1 <br /> Laboratory Name Col-UMg/l4 ff'•A/ftyfl C4(-. Sample Collected By(Name) Dq-A)l AL 81-1•ES <br /> U-HAUL <br /> Laboratory Work Order Collection Date Signature r <br /> Method of Shipment —OVE2A)[61#T <br /> MATRIX TYPE 1y1u' Analyses To Be Performed <br /> 1➢ry J_ <br /> N N U � <br /> E O 12 E <br /> 'O OI V C L <br /> 2) C m <br /> E <br /> W <br /> Cma <br /> Im p W <br /> Z 2 + Emp O <br /> E QN e <br /> E nm O <br /> '� <br /> E 11 n 'DOM EE E O . ¢c- <br /> m^ iatC_om <br /> O-V\ <br /> Remarks <br /> m n n n <br /> y J o z y3 c7Uo m m y mm F- O � o_ m am > m mm ecu F, c as <br /> 7-1-1 1,41 a @1'�f S 12 1N L3=� X XX <br /> @ I ) 5 D 3.'t5 X X �( <br /> o I @ a:55 X X X <br /> Ta-a 1y, J@ 1 r �t 3 )o X X <br /> @ <br /> @ i s Iz 1 4 X X X <br /> Sp- �• @ X X X <br /> sP-3 @ ► s G X X X <br /> @ <br /> @ <br /> Special Instructions/Comments: LAB USE ONLY: <br /> Condition of Sample Custody Seals <br /> Temperature Received • < < Storage Location <br /> Notes <br /> ReIi quished By(Signature) Organization Date/rime Received By(Signature) Organization Date/Time ANALYSIS TAT(Circle Choice) <br /> RLIK-S 1 IY LTAT-Surcharges May Apply <br /> ❑24 Hours <br /> Relinquished By(Signature) Organization Date/Time Received By(Signature) Organization Date/Time ❑48 Hours <br /> Cl 72 Hours <br /> 1 Standard 7-10 days <br /> Relinquished By(Signature) Organization Datelrime R:::iv �e) D""ateme <br /> ��/Ti / - <br /> c1fTme9c� <br />