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IFIn <br /> ttitllitl�aciw0 nrvticaT <br /> 13StaA 423560 <br /> 911001 -0S CHAIN-OF-CUSTODY RECORD <br /> rf Analytical Request <br /> Client 1 ntReport <br /> pp Turn around Time <br /> Re ort 70 �2Arv1C T�S�S Pace Client No <br /> 4 �� E] 24 Hours <br /> Address 11.) b Bili To ��y` d ❑ 48 Hours Pace Project Manager <br /> N <br /> El 3-s Days <br /> ><t� �.JA 2.� � J�/5 <br /> } P O #/Billie Reference 7 � 3 E] 1 Week 2 Weeks Pace Pro ect No <br /> Phone �sl _ )�r( 57c. <br /> & kTaN AJ.AiArr, C.TAT�b� Normal 14 Days <br /> Pro ect Name/No 'Requested Due Date <br /> Sampled By(PRINT) W ANALYSES , <br /> cc PRESERVATIVES LU REQUEST <br /> Sampler Signature a <br /> Date Sampled Z 5;fr <br /> L <br /> LL w <br /> ' ° z ° Z REMARKS <br /> 1 M o-1 I3. 1•�i�' 7� x <br /> re <br /> 3 <br /> 7 <br /> -k'2- X <br /> 4 c t) —/0 Is- S <br /> 5 ZU-- 1 ;32, Y1� X �( <br /> 6 l� / <br /> 7 <br /> SHIPMENT METHOD AIR BILL NO. SHIPPING DA --l—LIISHED BY AFFILIATION DATE TIME ACCEPTED BY I AFFILIATIO <br /> I $ <br /> C> Z <br /> q130 ap 6 9 Q <br /> Additional Comments 2�1 <br /> 1:3A0 <br /> SAMPLE CONDITtON <br /> Temp Received on Ice Y N Sealed Cooler I N Samples Intact Y N <br /> SEE REVERSE SIDE FOR INSTRUCTIONS 8197 <br />