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o �� i ■� 3 <br /> TE tNotoGv �� ) ANALYSIS RE EST AND As-1- )062 Reference Document No. 49804 <br /> coRPORAT10N CHAIN OF CUSTODY RECORD* Page 1 of /_, m <br /> Project Name/No. 1 _ 7��/7 _ Samples Shipment Date 7_3' �--9.� Bill to:5_ ZT�CFJI� m <br /> — -- P P <br /> M <br /> Team de <br /> ',nniIembers z <br /> Lab Destination <br /> Profit Center No _ SM4yjLWX� <br /> �--�����0 Lab Contact 9 C <br /> J ,a <br /> Project Maoager4 _- -_- _ __ _ Project Contact/Phone <br /> -r m <br /> Purchase Order No.6 � <br /> Carrier/Waybill No. 13-- ' Report to:10-- _- -- -_ _ __ _ - <br /> N�� <br /> Required Report Data. <br /> _ A <br /> — O <br /> Sample 14Semple 15 Onte/Time 16 Container) Semple I pro. 19 20 -a -- --__ oral a <br /> Number Dearai on/T a Collected . T Velums servative Requested Testing Condition an 21 ecoid N 1� <br /> P—r�o-^rem Receipt Record No. 3 <br /> aP2-p b uzo --r i <br /> � i n <br /> n <br /> a <br /> von trs�«us rlr� <br /> 4 <br /> Mrs <br /> T.5 4 • n <br /> GOWCONL► Mf P <br /> "Do SPAC '00 <br /> Special Instructions: 29 <br /> Possible Hazard Identification: 24 Sample Disposal. z5 <br /> Non hazard� Flammable I_J Skin Irritant y Poison 8 IJ Unknown I <br /> Return to Client�a Disposal by LatsI Archive _ _______ (mos-) <br /> I urnarnu I Time Required: 26 QC el: 27 m. <br /> IJuI males Rdsh Lid— 10„iJ IA.IA Pro <br /> S 'Pili' (s ci J <br /> --- -- ----- va' <br /> 1 flelinquished h Date:. -� 1. Received b 28 <br /> - - -- <br /> r..r,�n���rng�ea��,l y �` Date: m <br /> F <br /> isignamre/A11ainNun) C Time: -- - - Lt n <br /> 2 Relinquished by Date: 2. Received b <br /> w <br /> Time: (Signature/A(Gliatinn) ate' __ --- -__-_-___ _ <br /> 3. Relinquished by Date: Time: m <br /> _ 3. Received by Date: ^' <br /> Time <br /> f.or nments: 29 Time: <br />