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CS ervi c e S���olumbia <br /> Analvtical <br /> � <br /> Courier Sample Receipt Record <br /> Date <br /> Companv E tm G'I\j <br /> Project No I-T�S-z3M cc., 1-775 --Z 12 �� � 1 l�?s_azU u01 , t -27s-700 Cot � Z527rruu �ciZ <br /> Number of Containers � Coolers Boxes ? Other <br /> Custodv Seals) Present (ES) <br /> NO Custodv Seal(s) Added YES NO <br /> r <br /> Containers Relinquished By Signea Name <br /> Pnnted Name <br /> Companv <br /> Date and Time <br /> Containers Recesved By (Courier): Shed Namer�- <br /> Printed Name 7` 1<-14/V ,moo L, <br /> Companv n/�L'-� �� �,n/a _— <br /> Date and Time ��//�� S� %� 0 7 -�7w1 <br /> Containers Relinquished By (Courier):Signed Name <br /> Pnnted Name rhe O L <br /> Companv Lc. t�CLv <br /> Date and Time /b M <br /> Containers Received By (Lab): Signed Name <br /> Printed Name <br /> Company — <br /> Date and Time A 24 <br /> Mote Samples received via courser niil be officially received and processed at CAS' Sample Re=vmg Office <br /> 1921 Ringwood Avenue, San Jose. CaUbmia 95131 <br /> Telephone: 408-437-2400 Fax: 408-437-9356 <br /> cotnttFAinoc 4,r795 <br />