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r <br /> y <br /> � 40 i <br /> SAMPLING/ANALYSIS REQUEST AND CHAIN OF CUSTODY RECORD � <br /> Project No.: <br /> Requested BY: � <br /> Pac � P.O. No.: <br /> REQUEST LABORATORY REQUIREMENTS <br /> SAMPLE TYPE: �j <br /> CHAIN OF CUSTODY <br /> CQNTA)1+lERS <br /> SA1.IPLE I.D. PAnaMETERSXQONTRACT LABORATORY <br /> SIZE/TYPE QUANTITY LIE <br /> PRES. SAMPLER a <br /> �/bi . N$ DATE SAMPLE DATE RECD Ry <br /> COMMENTS DATE <br /> V i Ate ! <br /> Kc <br /> 4_3 <br /> � � L <br /> "SIGNATURES: <br /> Re nquishe�c E3y' �on,It <br /> f Or ni�a/tlan Oa[a/Tuna <br /> f /t. niv0d 8y(Slgnalure) 5 <br /> alinquihedbYfSignarur��I rr S'zr �� I -/_A'I��� Da1o/TLmo <br /> 1 Organirarian ! T7v Turn Around Time <br /> Date/Time 17ocelvedfly pignatura) *� ;U SCircleCligice) <br /> Aelinquishud Ely iSignarule) Orgoniiarion Dalefn <br /> Organisation 24 11as <br /> Dalo/rima Recnivad For Laboraror 0 40 Hrs <br /> - ----•— Y YlSignalurc) n 5Days <br /> i <br /> i <br />