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INTERNATIONAL <br /> TECHNOLOGY CHAIN-OF-CUSTODY R/A Control No. <br /> CORPORATION RECORD <br /> C/C Control No. <br /> PROJECT NAME/NUMBER LAB DESTINATION <br /> �—Tr—rr•�CrJ <br /> SAMPLE TEAM MEMBERS Peggy L7.ewellyn CARRIER/WAYBILL NO. <br /> Sample Sample Date and Time Sample Container Condition on Receipt Disposal <br /> Number Location and Description Collected Type Type (Name and Date) Record,No. <br /> ti,,,• ni, <br /> Lab # 34437 (stoner) <br /> 11 ;0() 1r <br /> "'19 ),ore-ho7.e T-7 15-1r.5 fer t 1!/26/F'5 <br /> ?.ab 344'33 stoner <br /> Ar <br /> A,� e <br /> b <br /> Special Instructions: r/•t, f , , <br /> � . <br /> Possible Sample Hazards: <br /> SIGNATURES: (Name, Company, Date and Time) <br /> �.. ops j Cor to Ftp, r "" �" 3. Relinquished By: <br /> 1. Relinquished y. _ 1 P.x re^ 1 " <br /> Received By: {� Received by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-To accompany samples <br /> YELLOW-Field copy <br />