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M.CUbA FTa I Irar 4T3 4 <br /> ggC6 CHS IN-OF-CUSTOD RECORD <br /> Analyttcal Request <br /> n �1 Turn around Time <br /> Ghent Report To 2 rT� iOa 5 Pace Client No <br /> ❑ 24 Hours <br /> Address 3 2 U �.) - LJ +S-To rJ A�� Bill To ❑ 48 Hours Pace Project Manager <br /> ❑ 3-5 Days <br /> P O #/Billing Reference `��G 3 �] 1 Week 2 Weeks Pace Project No <br /> Phone S�U S r � ' Pro ect Name/No �OU To n! Ytleo ❑ Normal 14 Days <br /> 'Requested Due Date <br /> Sampled By(�I TJ cc PRESERVATIVES ANALYSES <br /> T <br /> R�auEsT <br /> � <br /> Sampler Si nature Date Sampled Z > <br /> O a- O O Q <br /> SAMPLE DESCRIPTION TIME MATRIX PACE NO. <br /> zITEM x = ° z REMARKS <br /> ' I qw - 1 r-7 <br /> 2 1v1 w — I Z. �iLz� ZC? <br /> 3 W _ X535 x fY <br /> a <br /> _ I <br /> 5 > <br /> 16 <br /> 7 <br /> 8 <br /> IN UMSER ITEM <br /> SHIPMENT •• AIR BILL NO, SHIPPI -O-FCOOLERS NUMIE11RELINQUISHED fBY I AFFILIATIONf <br /> tt r l:► ss ¢�a 2Q g /Yau f<L) E)C 2419t <br /> Additional Comments <br /> SAMPLE CONDITION <br /> Temp °C Received on Ice Y 1 N Sealed Cooler Y 1 N Samples Intact Y/N <br /> SEE REVERSE SIDE FOR INSTRUCTIONS a97 <br />