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1 <br /> INTERNATIONAL® R/A Control No. � <br /> TECHNOLOGY <br /> CORPORATION CHAIN-OF-CUSTODY RECORD <br /> /' C/C Control No. 001510 <br /> PROJECTNAME/NUMBER + uf-17a4l�- 1 IH606(03 LABD =�— <br /> ESTINATION �Sld"22A -Sa'l't-ia aa44( <br /> SAMPLE TEAM MEMBERS - 9� �E CARRIER/WAYBILL NO. <br /> Sample Sample Date and Time Sample Container Condition on Receipt Disposal <br /> Number Location and Description Collected Type Type (Name and Date) Record No. <br /> (ft2tiJi02 <br /> i <br /> Special Instructions: <br /> Possible Sample Hazards: i <br /> SIGNATURES: (Name, Company, Date and Time) <br /> 1. Relinquishad _��` / Mkt Relinquished By: <br /> �- �/C <br /> 1, ! Ct'u� f-< tYK'c Nt^ // _! �✓'C'fir! Received by: <br /> Received By: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy <br />