Laserfiche WebLink
a ALPHA SCIENTIFIC CORPORATION <br />,W&I/ <br />CHAIN OF CUSTODY RECORD <br />Page of _ <br />Lab Job Number <br />C Client: t_ r� <br />, <br />1 t/ I! a) �� NSI=/i/ L (�' LI "�'T t, <br />Analyses Requested <br />T.A.T. Requested <br />i;�-Rush 8 12 24 hrs <br />❑ 2-3 days o Normal <br />Address <br />o <br />°° <br />o <br />°° <br />cl <br />x <br />o <br />N <br />°O <br />% <br />t <br />U <br />O <br />o <br />N <br />°° <br />U <br />o <br />N <br />°° <br />ti <br />b <br />U <br />j <br />„) <br />Report Attention <br />Phone <br />Fax <br />Sampled by <br />Sample Condition <br />billed Intact <br />❑ Sample seals <br />Project Name/No. <br />Project Site <br />I <br />Client <br />Sample ID <br />Lab <br />Sample ID <br />Sample Collect <br />Matrix. <br />Type <br />Sample <br />Presery <br />No.,type* <br />& size ofo <br />container <br />Remark <br />Date <br />Time <br />KJ 1I <br />I <br />I <br />i <br />E <br />1 <br />i <br />jRelinquishs 1 by,, i Company <br />Date <br />i <br />Time <br />Received b Com zany <br />Date <br />j <br />Time <br />Container types: Me <br />A=Air Bag P= t l bo ble <br />bottle V=VOA vial <br />1 Relinquished by Company <br />4 <br />Date <br />Time <br />Received by Company <br />Date <br />TimeG=Glass <br />Alpha Scientific Corporation Note: Samples are discarded 30 days after results are reported unless other arrangements are <br />16760 Gridley Road Tel: (562) 809-8880 made. Hazardous samples will be returned to client or disposed of at client's expense. <br />0P,•,-4— CA QmM Fax (562) ROMR01 Distribution: WHITE, with rencrt_ PINK to courier. <br />