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�t a I' 1a � � a a � � !� � r 11� �!• � � a a <br /> TECHNDVIMMOLOGY <br /> L ANALYSIS REQUEST AND Reference Document No. 3 3 7 9 4 3 <br /> CORPORATION CHAIN OF CUSTODY RECORD* Page 1 of <br /> Project Name/No, 1 CA +u/190976 Samples Shipment Date 7 -F�kc��n up IZ-z'i1 Bill to:5 --LIT orctzbrZ'vTlor> <br /> Sample Team Members 2 - +7. -B14Nwn1 Lab Destination 8 —F�cE , K)oVKTTo 4 �Q5 -Fw_"eg2 <br /> Profit Center No. 3 E!> 4 l Lab Contact 9 CARorJ =Qt-SVAG "ArelnN4, CA 445E,,� 0 <br /> Project Manager 'T1 " ANTU Project Contact/Phone 12-T• 4r.1eWoe11(�w)_4n-9100 0 <br /> s Report to:10 3 <br /> Purchase Order No. Carrier/Waybill No, 13 <br /> Required Report Date 11 12 5-9 I m <br /> s 3 <br /> v <br /> Sample 14 Sample 15 Datums l8 Contains1 Sample pro 19 20 m <br /> Number /T Cdleeted T Volume servatiw A"uested Testing Condition on 21 Disposal 22 <br /> Program p Record <br /> I1z�1MWi Gr ka>w4iL2 d-2791 1315 g9mL\t0A 40 .1 NCL -1—F+1(G) <br /> 1z� <br /> 0 <br /> N_ <br /> � I d <br /> r p <br /> O <br /> 6WHL FkV SQ7Nc VC CN L-o211>eS T1�5 <br /> 4:4 f 4"MM I F 141-,Wq N I T-rZATe��'> <br /> Doak, Ch F <br /> o � <br /> Special Instructions: 23 0 <br /> 3 <br /> Possible Haz�f d Identification: 24 Sample Disposal: zs o <br /> Non-hazard./1 Flammable J Skin Irritant J Poison B J Unknown 'J Return to Client J Disposal by Lab J Archive (mos.) <br /> Turnaround Time Required: 28 OC level: 27 <br /> Normal J Rustr� I J 11.1-J III. J Pro ect S c (s <br /> 1 . Relinquished7128 Date: 17-Z-91 1. Received b <br /> Isignawre/Af6liaGon) Y Date: <br /> Time: 1O�o ISgnawre/AHdiadoo) Time: 2 <br /> 2. Relinquished Date: L- 7-- <br /> Isignewre/APobetion) r y 2. Received Date:TimeIS9newre/ARdaUon) N <br /> 4 2, . - <br /> Time:— <br /> 3. Relinquished by Date: 3. Received by(5'9nawre/APohaGon) - -- Time:-- <br /> Date: 12_ 2 Q! <br /> Comments-29 <br /> Time: 12 '1- <br />