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INTERNATIONAL R/A Control No. <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD <br /> CORPORATION 258513 <br /> ! C/C Control No. <br /> PROJECT NAME/NUMBERI RNC / f 9Ct9Z LAB DESTINATION <br /> ,y <br /> SAMPLE TEAM MEMBERS � 'V -&AAJ�^ 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 /> 6-179/ SOI L X !U£C <br /> .� i�� fig• /'�' <br /> 'C-0I L <br /> S 'II ��,� <br /> 4 Special Instructions: '�� h r1241 .. <br /> Possible Sample Hazards: <br /> t <br /> SIGNATURES: (Name, Company, Date and Time) <br /> 1. Relinquished By: ` ff L' 3. Relinquished By: <br /> Received By: O g/ 3 Received by: <br /> 2. Relinquished By: 4. Relinquished By: <br /> Received By: Received By: <br /> WHITE-T- -ampany samples <br /> i3 YELLOW (aoPY 127A 10-85 <br /> rAA <br />