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WL4�►L� i� �N .1 Two � FIE �nr��ocw■■er <br /> LOGY CHAIN OF CUS ECORD* Page 1 of _ — <br /> Protect Name/Na 1 �''r3 Samples Shipment Date 7 ` �_—�_ Bill to 5 � ! ) -4 <br /> Sample Team Members Lab Destbnation t /AS efl__ <br /> — /S ` n <br /> Profit Center No. a Lab Contact g N - - --- <br /> Protect Manager4 P a5 Protect Contact/Phone 12 ? Report to-'-0 <br /> .s � 1h Carrier/Waybill No. 13 5�ig S 1/ <br /> Purchase Order No <br /> Required Report Date 11 + -- - N <br /> 16 1 Sum la1 Pre. 19 A ueeted Testis 20 couditbn on 21 Dmposel 22 <br /> Sample 14 sample 15 Dote/ mw Container Volume MeevatlYe Aaoa ]� ��''}yR//e`,cord No. <br /> Number Collected em U I"I,V <br /> L l 7 i a1E'a �9 1 L 5 <br /> r'*p <br /> n <br /> MLY 0 <br /> F-11168 rrmll Li <br /> n 1v u <br /> m <br /> qwr new Ia <br /> m <br /> ;3 <br /> a <br /> Special Instructions: 23 <br /> a <br /> Possible rd Identification: 24 Sample Disposal: z5 <br /> Non-hazard Flammable ❑ Skin Irritant IJ Poison B [a Unknown 13 Return to Client Disposal by Lab Archive [mos 1 n <br /> r <br /> Turnaropnd Time Required: x6 OC Level:27 <br /> Norma Rushu I I II 11113 Project Specific (specify).- <br /> 1 <br /> s eco )._ _ re <br /> Date. 1 01 1 Received n <br /> 1 Relinquished by by 28 k Date <br /> (Sgnewre/AfC�MetJaQ �� w ! Time I i5oneewra/affi�eNa,l '��' t Time / <br /> 2 Relinquished Date 2. Received by Datei <br /> (r%Wiewm/afrdmwn) Time ffVmU"/afFffwdw) Time <br /> Date. 3. Received Date <br /> 3 Relinquished by by <br /> (Sigiewm/afts,en) Time- F-dwksan/a l Time- <br /> Comments.29 <br /> Mr uI5s+ <br />