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R <br /> ftASnOINAL A a ORePeencRocAnt 511 <br /> ANALYSIS REGMT <br /> TECMOLOW CHAIN OF CUSTODY RECORD* Pagel of 2 <br /> COM 5- <br /> Project Name/No f'Flqr- P-49-4-- iQ49 i` _ Samples Shipment Date 7_ = r=4 Z Bill to 5 - _ <br /> 2 �. ;3AfJniou s r-r4� - y� c� "rro �u1D a <br /> Sample Team Members_ _ _ _ Lab Destinataon _ _ __ ___ �— _+►1/irz1�&CZ�C4 co <br /> Profit Center No 3 351 I _ _ _ __ Lab Contact 9 HiuTT <br /> Project Manager- 'Ng"�+ 7n - Project Contact/Phone t2�.�ul�rc�7>z1�5�� Report to 1° - <br /> 6 �` Carrier/Waybill No t3 --- — -- - -- -- - <br /> Purchase Order No _ _ _ _ _ _ _ � __ ------- _— ---_--- -- 3 <br /> Required Report Date <br /> SampN 14 Sample 15 Oste/Time 16 Contained mptel � 19 Testing 20 Condition on 21 Disposel 22 <br /> Number Collected T Vofums emvattrs R Recd No. <br /> C 2"A womet? v Iwo voA <br /> r: r-14 <br /> Nc.L <br /> Q <br /> o33o9zr�3 r� i�AUse /Ito var3 4o+t _►'� (6)/wex <br /> 5 Ili E � <br /> CD <br /> Cr <br /> C <br /> Amocox <br /> 0 <br /> Special Instructions 23 <br /> 2a Sample Disposal 25 6 <br /> Possible Hazard Identification P P <br /> ienlrl'r Disposal by Lab <br /> Non-hazard 4;;k' Flammable A Skin Irritant IJ Poison B IJ Unknown �� Return to Cl5� Archive (Mos )} o <br /> n <br /> Turnaround Time Required 26 GIC Level 27 m <br /> Normal' Rush1 II�,� III Project Specific_(speck)_ -- - - :3 <br /> 1 Relinquished by 2 Date _3 -31-4Z___ 1 Received by 28 Date _ C <br /> i5ognewm/Affifiatm) 1 Time i /Arfihau-1 Time o <br /> Date _ 2 Received by Date _ <br /> 2 Relinquished by - - - _ <br /> i5�gnatura/Arifiadon) /A <br /> Time Isenew� lfillatroni Time <br /> 3 Relinquished by Date _ _ 3 Received by Date _ <br /> i5lgnature/Affihauon] Time (Sgnw"/AffihaWnl Time <br /> Comments 29 <br /> ARCA T15M <br />