Laserfiche WebLink
G 1 <br /> iNT�RN11T10HAL on, <br /> TBCHNOLOWANftYSIS REQUEST ANO Reference Document No. tJ 0 0 3 r� %1 <br /> CCOPOUMN � CHAIN OF CUSTODY RECORD* Page 1 of <br /> p <br /> Samples Shipment Date �__.r���.�.� ! <br /> - - - Bill rte: -- _ <br /> - ___w. _... . r6�n <br /> Lob Destination A_1-ule TeamMembers. P <br /> �-.__.._...___... <br /> Profit centerNa. � <br /> 3 _ Lab Contact <br /> _ J1�.1_��,b.._ - <br /> Project Manager' -L: Project Contact/Phone ix4�t � ii w 3�— rt ta: . r <br /> Purchase s - Report - <br /> Drder No...__ �_ �! ._ Camier/WaybM No. i3 N�x�► _ _ ._ __- -- ----Required -- <br /> Report Gate��_- O�f!�►.v�� ---.._ <br /> A-ir <br /> $amp 9ew4ft 15 <br /> NiNbw sawwb a Pro- w ud Tacnezo endidew on2t _ 22 ` <br /> I'D11110 04 S LL �._ 52719 <br /> (W9 cis Mwx <br /> a lam"" L �► !► <br /> I), ,1 <br /> trig <br /> 6 <br /> U >t t S R(3 �=�h�4 (j��.•��• t� o �L A.�kt L Al4..► T �� r S Q, " <br /> S t- 4 S Mw S C�Y¢..,,,�.,, l�.'" '4 s EPA w.od 3 v/S <br /> �4 52720 jowe . tr <br /> s <br /> WME <br /> ..,,,. <br /> Vhl!"Aid SPACE <br /> Special Instructions: 23 <br /> Possible Hazard Identification: 24 Sample Disposal: 25 <br /> Non•hazard 'J FUNTw gable j Skin lrrW* I.J. Poison 8 tj Unknown lj Retuim to Chant fJ Disposal <br /> by Lab I j archiuoa__...____.__ (rnos.) <br /> Turnaround Time Required: 26 OC Level:27 <br /> Ncm•mal 16 Rushj LI Ill.l 'is <br /> 1. Reltnguished by Date: I. Received by 28 Date: <br /> Time: a in+ ,i c Time: ��- <br /> ? Relinquished by <br /> !Wq,*ff*/A1*&w0 q Q -___—�__. BC by Da%e. <br /> Time.- 1I9WW1&"1AM6aWmj <br /> Time: <br /> 3 nelkiquislmd by Date: 3. Received by Date: <br /> Tine: r�sw�•a.�n � r,rne:----- .--------._ <br /> 7omments:29 <br />