Laserfiche WebLink
r ,�r r rr r r ■r r r r ■��7 r <br /> CHAIN-OF-CUSTODY RECORD <br /> Analytical Request <br /> Client Report To ��� >�0 rJ S Pace Client No <br /> Address Is ZG A ON S Bill To S M Pace Project Manager <br /> P O #/Billing Reference 3:Owi Pace Project No �t o" 7- <br /> A <br /> Phone -J t O ��5 — _ Pro ect Name 1 No T0CgDrj 00er4 *Requested Due Date <br /> Sampled By(PRINT) /� E� . a PRESERVATIVES SES <br /> Lu REQUEST <br /> Sampl r ignature Date Sampled ~ L LU� <br /> W Ag* M E$.¢zf� u I b ��� o �z ° ° <br /> DESCRIPTIONm o s h 4�o <br /> p <br /> ITEM SAMPLE <br /> REMARKS <br /> 2 1105 :��►,t ? - - , - - - - <br /> 3 m,� - 3 034 jognFl 1 <br /> 5 � -5 KID ?ail-r4191 � <br /> Z 146 <br /> 8rn e t y 31'1198 <br /> W ( ,ta4u'17 2 <br /> METHODSHIPMENT RELINQUISHED BY AFFILIATION • BY AFFILIATIONDATE <br /> COOLER • OUTDATERETURNED DATE <br /> 'T <br /> Additional Comments <br /> NOT 1NjACS❑N� ' <br /> ;O(ILERCl1STODYSEALS INTACT❑ <br /> �� 5 � °C <br /> COOLER TEMKRATU 6 t g SEE REVERSE SIDE FOR INSTRUCTIONS <br /> ORIGINAL <br />