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w <br /> h <br /> .alL <br /> INTERNATIONAL <br /> TECHNOLOGY <br /> CORPORATION CHAIN-OF-CUSTODY RECORD RIA Control No. <br /> .. GIC Control No. 197996 <br /> PROJECT NAMEINUMBER � � 1V LAB DESTINATION t '}`5� <br /> SAMPLE TEAM MEMBERS !.Aj( r} CARRIER/WAYBILL NO. <br /> 'i <br /> Sample ! Sample ..nd Time <br /> t 'r <br /> Number Location and Description Collected Sample Contai;er Condition on Receipt Disposal <br /> Type Type (Name and Date i <br /> J I Record No. <br /> �{j Sr 'r <br /> 14 <br /> 6- <br /> =� <br /> r0c) <br /> I a <br /> � F <br /> 1.3u <br /> I 1 1145 r a <br /> Special Instructions: '� ^ <br /> Possible Sample Hazards: �f_- `1, �-�"� �a i�� 11 t_ V\ VA . 1''I X <br /> a. <br /> SIGNATURES: (Name,Comp ny, Date a�d Time) <br /> 7. Relinquished By:' <br /> 3. Relinquished By: <br /> Received By: _ _ r�r\V/ �./ S / a <br /> (1\U1 <br /> Received by: <br /> 2. Relinquished 18y: 4. Relinquished By: «; <br /> Received By: <br /> Received By: .. <br /> a <br /> WHITE-Toacc ."any!samples <br /> YELLOW Fie f-, <br /> j <br />