Laserfiche WebLink
a <br /> 1 z <br /> INTERNATIONAL R/A Control No. - <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD <br /> CORPORATION CIC Control No. 50 7 03 � <br /> PROJECT NAME/NUMBER Y� — �52— LAB DESTINATION � �Q <br /> SAMPE.E TEAMMEMBERS CARRIERIWAYBILL W. <br /> Date and Time S <br /> Sample Semple ample Container Condition on Receipt Disposal <br /> Number Location and Description Collected .Type Type (Name and Date) Rrtord No, 3 <br /> 4 � <br /> 55 —5--E cad <br /> 55 --6-�,� Gl ugh- lf5o _ <br /> SST � � 4 <br /> SS�F tom � �1IS <br /> �i. <br /> Special,Instructions: ' <br /> Possible Sample Hazards: <br /> SIGNATURES: (Name,Corry an Date• Time) 21A11 <br /> �( dw :a <br /> 1. Relinquished 8y' 3. Relinquished By: �:a <br /> Rec�eivec!3y: <br /> Received by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: _ Received By: — <br /> li <br /> L ...WITEmr <br /> �. 71If <br /> - -.'YcLLbY -realdcopy"' <br /> l <br /> , <br /> i <br />