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m INTERNATIONAL - <br /> TECHNOLOGY R/A Control No. <br /> CHAIN-OF-CUSTODY RECORD <br /> CORPORATION 265178 <br /> C/C Control No. <br /> PROJECT NAME/NUMBER ���`� N`tO Z.ZLABDESTINATION M2n_St -"Tod! <br /> SAMPLE TEAM MEMBERS'--;�)•_ �)e e-QCARRIER/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 /> v(A --0; e T ra: l 11 <br /> o2A k t <br /> 03A tt \z4 <br /> 04A t <br /> D5�A It k \ l3 <br /> otoA t S <br /> 0-7A 1356 <br /> 0M 14t <br /> Special Instructions: ?A Ir— <br /> Possible Sample Hazards: <br /> SIGNATURES: (Name, Company, Date and Time) <br /> 1. Relinquished Byy�� `� n ;^=1 on'-f> 11h619, 3. Relinquished By: <br /> Received By: 11 A IV II�(A! "oULJ U9 S Received by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy <br /> 127A-10-65 <br />