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INTERNATIONAL <br /> TECHNOLOGY R/A Conlrol No. 2-300.) <br /> - - - CnItPORATION CHAIN-OF-CUSTODY RECORD <br /> C/C Control No., 197968 <br /> ;.r <br /> PRpJECT NAME/NUMBER i~1,�'. -'i=! j'' LA8 DESTINATION, <br /> SAMPLE TEAM MEMBERS CARRIER/WAYBILL NO. <br /> 7Nu- <br /> �ber <br /> e ' <br /> �. Sample Date and Time Sample Container Condition on Receipt ;Disposal <br /> Number 1 Location and Description Coiiacted Type Type (Namn and Date) Record No, <br /> Ih 3 iii- <br /> J�130 t a' <br /> r Lal I-'I I <br /> IP 15 <br /> s <br /> y- 5, <br /> fir+ ,r �J! �r•t--� �fi}� <br /> Special Instructions: , <br /> Possible Sample Hazards: �_ t: i ~> _ �'` r I n C,U j r <br /> SIGNATURES:I' (Name,Company,Date and lime) <br /> T <br /> 1. Relinquished By:!>~�,� ��'" %�` .?1F-1- 3. Relinquished By: <br /> Received By. <br /> Received by: <br /> 2, Relinquished By: 4. Relinquished By: <br /> Received By: Received By: _ Y <br /> f <br /> YEt_LCW Fief - yxamptes ! ....s <br /> WHITE To acK an <br /> 1 <br /> r, <br />