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° ANLYN RdNEAN8MIefere' DTment U b <br /> r <br /> rkrCORP°°, CH_ AIN OF CUSTODY; RECORD* F; Page 1' of - 3 <br /> ! <br /> Project Name/No i " L I 1samples Shipment Date 7 ` =;�• fL - C - <br /> Bill to $ I . C_ r�11 I <br /> Sample Team Members 2_ ,.il Knoi+ �4 i Lab Destination'8"_�r�,Ls;b,��� — P i4 <br /> Profit Center No 3 - Z.Sri l - <br /> Lab Contact 9 - <br /> s4 l7 <br /> 1 <br /> Project Manager4 ' 1l5 Project Contact/Phone �� 'i� - 3c � y 12--(A - <br /> Purchase Order No -- � '13 � R apart <br /> ° to <br /> Carrier/Waybill No _-- b dab, <br /> Required Report Date_1 L rJ n"Y --: - <br /> OVE <br /> w ■ <br /> Sample 14, Sample 15 Dote/Time 16 Container, Sampiei ` Pre. 19 Requested Testing 20c Condition on 21, Disposal 22 <br /> Number no on a Collected T s Volume eerwative rem <br /> •u ' Receipt Record No. <br /> N_ �L, w - v <br /> •� II h [ t t <br /> [ � �. 7 E� JJV4 A <br /> tA <br /> 1 r N 7 <br /> - 1 � 51 ��� v i , = V - ^ I .; i,- d' l <br /> f <br /> ' m [ <br /> I r - , r <br /> r <br /> [ <br /> LF 14 C <br /> L3O <br /> k A, _ I <br /> i <br /> _ n+ [ <br /> r ` <br /> 17t� r- a ,,kw ` <br /> [ <br /> € r <br /> Special Instructions- 23 _ <br /> Possible Hazard Identification. 24 Sample Disposal. 25 r <br /> Non-hazard Flammable IJ Skin I rUnt IJ Poison B I.1 Unknown'FA- Return to Client LA Disposal by Lab Ell Archive [mos ) <br /> Turnaround Time Required 26 DC Level.27 ' <br /> Normal RushF.J I it I� III Proect Secific (s eci ). <br /> 1 Relinquished by 2%er�� Date <br /> (Slgnawm/AffiSeGonl .__ 1 Received by 28 Date - <br /> — r <br /> Time IsreoWre/AffiGmonJTime <br /> 2 Relinquished by Date 2 Received by Date <br /> (S powm/Affiliation) Time JSrgnaWm/AffihaCanj <br /> Time <br /> 3 Relinquished by Date 3 Received by Date <br /> (Sigma a/Affibewn) Time f5lgnature/AifrheUon) Time — <br /> Comments:29 <br /> r <br /> tCAT,5Mt <br />