Laserfiche WebLink
® INTERNATIONAL �� f I C5 <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD R/A Control No. Z�G,hS� <br /> CORPORATION <br /> C/C Control No. 265177 <br /> PROJECT NAME/NUMBER— >i� �C`)C L4ri1J ��(OagZ•Z LAB DESTINATION <br /> SAMPLE TEAM MEMBERS en t-1py 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 /> D�1 A <br /> Il c0.5 2Q.1 <br /> /OR %kc),53pa 1 1 10 <br /> 11A t t \� <br /> /2A n 1V <br /> 13A lkoalpis \ <br /> 1 qA I 1 11 <br /> SSA 11055P1 1 <br /> I&A uo55 lt4p <br /> 17AIko- <br /> jetl lSo <br /> 4A \t055 \200 <br /> Special Instructions: 2 Fj Ir,,r —17"? J �rrxiJ� <br /> ' Possible Sample Hazards: <br /> SIGNATURES: (Name, Company, Date and Time) <br /> 1. Relinquished B `Sf�L ZT n ll I6�41 3. Relinquished By: <br /> Received By: 1 —��� ( /S Received by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy 127A-1085 <br />