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Nr►t� N SI E S7 1D I re)?Da�'lel�. � 7� <br /> ToLo�r Page 1 of <br /> coi�oaA�orr CHAIN OF COSTO Y RECORD 9 � <br /> Pro'ect Name/No. 1$;? PloetM•°`3amples Shipment Date LAr� 3-10-42 Bill to:5 <br /> l 2�. +�.ao� Lab Destination <br /> s <br /> Sample Team Members <br /> Profit Center No. 3 � 41 Lab Contact 9 A i'�� C� - <br /> 12 Z; (s+o 3TZ1l ioa <br /> Project Menager4_S.._�--I I U-S _ _ Project Contact/Phone - ,- -- --.-- --�-- —— Report Lo:10_ <br /> Purchase Order No.s �^ carrier/Waybill No. 9.3 <br /> � 3 <br /> Required Report Date 11 .3-Z�-9z a j w <br /> Sample 14 Sample 15 pete/fltne16 Conteinerl mplei pre• 19 Requested Testing 20 Condition on 21 disposal 22 <br /> Number n/T Colected T Volume servative rem Receipt Record No. <br /> c� <br /> D D9QzMW� c r e - 1230 \104 q6 HL I4cL: �G� 5-1� <br /> VIM I <br /> a am I= a . <br /> N€� n <br /> % <br /> -, g4� [n <br /> m <br /> rr Iva arkom <br /> tz <br /> m <br /> n <br /> 0 <br /> - - <br /> Special instructions: 23 <br /> Possible Hazard Identification: 24 Sample Disposal: zs N <br /> Nonfiazar'dr Flammable IJ Skin Irritant IJ Poison B I,I Unknown 1.1 Return to ClientDisposal by La{7+-I— Archive (mos.) <br /> Turnaround Time Required: 26 GIC Level:27 <br /> Turnaround <br /> Time 14� JI III. Pro'ectS Specific eci )� - <br /> s Date: 3-1 O�Q? 1. Received by 28 Date: _ /10 `�z_ <br /> 1 . Relinquished - Time: 9 <br /> [Signature/Affiiiatinn) 1 Time: 15ignature/Affivatim,) A p <br /> Date: -- 2. Received by Date:_ <br /> 2. Relinquished by fs+sn /Af, ) Time: <br /> (Signature/Affiliation) Time: <br /> 3. Relinquished by Date: _ 3. Received by Date:_ <br /> SSgnature/Affiliation) Time: Time: <br /> Comments:29 <br /> MCA X11"1 <br />