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7.""..'1 7-1 7. '-77 '"�� 'tel '�..-1 :771 7-71 :�""�7 —71 <br /> MUNATIONAL ANALYSIS REQUEST AND Reference Document No. 3 3 0 416 <br /> CTECIM°Rp,UM CHAIN OF CUSTODY RECORD* Page 1 of <br /> Project Name/No.—r' -- TGU- W 50-Samples Shipment Date 7 to-l5-'q':S- Bill to:5 <br /> Sample Team Members'2 SON Lab De�ined6n 8 <br /> _..-_�+AL.:—'ter—� <br /> Profit Center No. 3 - Lab Contacts '� • -- - -- ---- --- <br /> Project Manager 4 ��' 'S -4- Project Contact/Ohone 12 G-�l�G+�Xt�'r 10 <br /> Report to: _ <br /> Purchase Order No.s T Carrier/,Waybill No. 13 <br /> Required Report Date " <br /> Sample 14 Sample 15 Dets/Time 16 Contained mRle1 pre. 19 Requested lasting 20 Condition on 21 Disposal 22 <br /> Number Deem Collected Velums Nrvatiw ram As= No, <br /> 1. ev".0 � ?157 -�4b M STL`�t o <br /> CL <br /> SSS w arc oq <br /> st <br /> s 2 36 v. <br /> u <br /> CD <br /> Cr <br /> m <br /> D 13)3wo w <br /> Special Instructions: 23 <br /> Possible Haza�Identification: 24 Sample Dispos 25 <br /> Non-hazard� Flammable Skin Irritant 1-11 Poison B F Unknown Return to Client/-J, Disposal by Lab hive (mos.) m <br /> Turnaround Time Required: 26 DC el:27 m. <br /> Normal IJ Rushij La IL[__ 111.1j Pro'ect S ecific (s eci ):_._ -.- <br /> 1. Relinquished by Date:_10-V31. Received by Date: <br /> _(o E. A <br /> (Signau"/AflfillaWn) Time: � [s[an"1Afradon) Time: ---- <br /> 2. Relinquished by Date: 2. Received by Date: --- <br /> [S�gneage�aifilie�ionl Time: (agnau"/atfirebm) Time: <br /> 3. Relinquished by Date: 3. Received by Date: <br /> [SVewre/atfiHabw] Time: ftnob"/Affil"on) <br /> .Time: <br /> Comments:29 <br /> _ o <br /> AICA 3015181 <br />