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1 <br /> INTERNATCIONAL R/A Control No. <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD ' <br /> CORPORATION C/C Control No. 264909 <br /> AIUIE/NUMBER ^ - ._-fCC"K 1 0►`y LAB DESTINATION ! stn} A <br /> PROJECT N '- <br /> SAMPLE TEAM MEMBERS -- CARRIER/WAYBILL NO. <br /> Sample SampleDate and Time Sample Container CondEtion on Receipt Disposal <br /> Number Locallon and Dascdpllon Collacted Type Typo (Mame and Date) Racard No, , <br /> ." <br /> f�11, rt r_t =;,F <br /> _s ., <br /> x <br /> Special instructions: <br /> Possible Sample Hazards: t <br /> SIGNATURES: (Name,Comppy,Date and Time) ; <br /> e in wished By: ;�'' `"`""" 71 T Relinquished By: <br /> 1. RDIY <br /> I q A <br /> Received 8y: ,"y' — 91 - /`a `"` Received by: 1 <br /> 2. Relinqulshed By: 4. Relinquished By: 4r <br /> Received By: Received By: <br /> I <br /> i <br /> WHITE-7o accompany samples 127A" 065 / P! <br />