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INTERNATIONAL AMALVEDS namuas4 AMD Reference Document No. <br /> TECHNOLOGY <br /> CORPORATION CHAOM ®f: CUs7®Dv RECORD** Page 1 of � <br /> , <br /> LI,G[in/s�,.JS <br /> Project Name/No. Sby.-Cx/D•/•4 Samples Shipment Date 7 I/zc;�/kXD Bill to:5 <br /> Sample Team Members 2 k A A) Lab Destination a w I A- � -+ <br /> 0 <br /> Profit Center No. 3 Lab Contact 9 S-i,i K.4 <br /> Project Manager4 IN). ��r1"uo Project Contact/Phone 12 9Ilo �►Z�'�� v 10 3 <br /> Purchase Order No..6 Carrier/Waybill No. 13 <br /> Report to: KA�� ��? 1n�4����� m <br /> Required Report Date ti 2 � 9virh MfLfg� --- <br /> m` <br /> Sample 14 Sample 15 Dato/Tima16 Containort Sample E Pro- 19 Requested Tooting 20 Condition on 21 Disposal 22 <br /> Number Dooc ' tion/T o /Collected .1a Volume aeruativo P rem Rec®i t Record Wo. <br /> < <br /> ' �TExn <br /> —u EL <br /> �1 <br /> 0 <br /> ? I <br /> ' A] _01 <br /> Lo <br /> ILY -�� . <br /> / <br /> —07 0 <br /> m <br /> Special Instructions: 23 <br /> Possible Hazard Identification: 24Sample Disposal: 25 d <br /> Non-hazard Flammable Skin IrritantCly Poison B nl Unknown (]J Return to Client Disposal by Lab ] Archive _ (mos.) ow <br /> Turnaco�and Time Required: 26 DC Level:27 n. <br /> Normal7��. Rush;,� LU 11Q_4 11Q Project Specific ( eci l*, _ 5' <br /> 1. Relinquished by 26, ., �� Date: Z7 OJ 1. Received by 26 Date: <br /> (Signau"Mfuecion)i'' . L'�1� Time: ,Z — ts.enau,ra�aru�c w,) �.. <br /> Gt7l�t Time:�1�d o. <br /> 2. Relinquished by Date: 2. Received by Date: <br /> tsWiau"inl Time: tiaftatiwl <br /> Time: <br /> 3. Relinquished by Date: 3. Received by Date: <br /> (signawre/Ar Sation) Time: JSWmU roiarr6euonl <br /> Time: <br /> Comments:29 <br />