Laserfiche WebLink
IN ATIONAL. `ANALYSIS RE Reference <br /> TECHNOLOGY ST AND R f tante DOcumen 99498 <br /> CORPORATION CHAIN OF CUSTODY RECORD* Page 1 of 1 459.7 <br /> Project Name/No 1 SACC. _ _ _ _ _ Samples Shipment Date 7_Al7-6LR� Bill to 5 _J0,11— __ _ _ : <br /> Sample Team Members2 t_�'�-C� `P�_ Lab Destination 8r�fir_ _ -- 0 5 �'e.r-_5 <br /> '�- - m <br /> Profit Center No sv `--�--- -w------ Lab Contact 9 ___���� <br /> Project Manager 4� e� 7_ ss::. _ Project Contact/Phone �z.]c�.. _ ,�__ 10 -o <br /> Purchase Order No - __ Carrier/Waybill No 19 N - b�3 Report to - — --T - --- - ^ <br /> d _ <br /> Required Report Date " LJQs-jA_qJ _ ` IL114: -a <br /> - - - - <br /> - - <br /> Sample 14 Sample 15 Date/Time 16 Contained Samptel Pre- 19 24 21 22 <br /> P P Requested Testing Condition on Disposal <br /> Number Description/Type Collected T e Volume servative Program Receipt Record No <br /> / 12 �jTE x SOZd m <br /> []4L6t strl l 41Zd9L MCAS 3x40-1 WCL-. -Tp U �G[5 E <br /> L��Z�►'tvfZ IOZS �_� _r. <br /> �tr <br /> ' v� akor-11 r_1 IVA 19 91 if 0m <br /> Q <br /> PYA 2b r- 3b ` <br /> Y­�Ul r> <br /> If <br /> + � � <br /> ch <br /> a M <br /> Cr <br /> a3 <br /> C7 <br /> X <br /> P <br /> 0 <br /> Special Instructions 23 1 <br /> Possible Hazard Identification 24 Sample Disposal 25 0 <br /> Non-hazard �[J Flammable (J Skin irritant J Polson B f J Unknown l J Return to Client IJ Disposal by Lab UVJ Archive__ (mos } <br /> rD <br /> Turnaround Time Required 26QC Level 27 <br /> Normal ' Rush'_J 1 iJ II1J 111 1,,,J Project Specific <br /> 1 Relinquished bV 28 Date �� 1 Ste__ 1 Received by 28�� �� Date_!1� <br /> G� w <br /> (signature/Afflietton] Time (StgnaWre/Affilinuan) /` <br /> /1 �"" Time <br /> 2 Relinquished by Date 2 Received by Date V) <br /> (Sig n atu re/A ffibati on) <br /> Time [signature/Affiliatkon} Time <br /> 3 Relinquished by Date 3 Received by Date <br /> [Signature/Affiliation] — -- <br /> T(rpe [5ignauire/Affihauon] Time <br /> Comments 29 <br /> rnrn�mini <br />